Provider Demographics
NPI:1588194088
Name:FLEISCHMANN, JOHN W
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:FLEISCHMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SMOKE BOMB HILL DC GRUBER
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-643-2578
Mailing Address - Fax:
Practice Address - Street 1:U.S. ARMY DENTAL HEALTH ACTIVITY
Practice Address - Street 2:351 WEST 6TH STREET
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5641
Practice Address - Country:US
Practice Address - Phone:912-435-7006
Practice Address - Fax:912-435-7045
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00203167122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF425429887116OtherDRIVERS LICENSE NUMBER
1473478800OtherDEPARTMENT OF DEFENSE NUMBER