Provider Demographics
NPI:1508929878
Name:FLECKLES, CLAIRE MARIE (RDHAP)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:MARIE
Last Name:FLECKLES
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1271 WASHINGTON AVE
Mailing Address - Street 2:810
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-3646
Mailing Address - Country:US
Mailing Address - Phone:510-228-5804
Mailing Address - Fax:510-227-5804
Practice Address - Street 1:1271 WASHINGTON AVE
Practice Address - Street 2:810
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-3646
Practice Address - Country:US
Practice Address - Phone:510-227-5804
Practice Address - Fax:510-227-5804
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDHAP42124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist