Provider Demographics
NPI:1295032167
Name:FLEMING, MARK DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:FLEMING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250-6822
Mailing Address - Country:US
Mailing Address - Phone:206-274-0185
Mailing Address - Fax:
Practice Address - Street 1:61 TIMBER LN
Practice Address - Street 2:
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250-6822
Practice Address - Country:US
Practice Address - Phone:206-274-0185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000007515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist