Provider Demographics
NPI:1518110014
Name:PATRICKA. FLEEGE, DDS, INC, PS
Entity Type:Organization
Organization Name:PATRICKA. FLEEGE, DDS, INC, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:FLEEGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-282-2285
Mailing Address - Street 1:PO BOX 99654
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98139-0654
Mailing Address - Country:US
Mailing Address - Phone:206-282-2285
Mailing Address - Fax:
Practice Address - Street 1:3621 29TH AVE W
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199-1746
Practice Address - Country:US
Practice Address - Phone:206-282-2285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA39301223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty