Provider Demographics
NPI:1578864401
Name:FLEISCHMANN, CARL JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:JOSEPH
Last Name:FLEISCHMANN
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 1:2041 BRONZE STAR DR STE 100
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95776-5428
Mailing Address - Country:US
Mailing Address - Phone:530-662-7592
Mailing Address - Fax:530-668-6526
Practice Address - Street 1:2041 BRONZE STAR DR STE 100
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95776-5428
Practice Address - Country:US
Practice Address - Phone:530-662-7592
Practice Address - Fax:530-668-6526
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA597321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice