Provider Demographics
NPI:1619063195
Name:FLEMING, NATHAN HENRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:HENRY
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 1:1018 REGIS COURT
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4404
Mailing Address - Country:US
Mailing Address - Phone:715-832-8063
Mailing Address - Fax:715-835-1231
Practice Address - Street 1:1018 REGIS COURT
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4404
Practice Address - Country:US
Practice Address - Phone:715-832-8063
Practice Address - Fax:715-835-1231
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5646-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33781700Medicaid
WI5646-015OtherLISCENSE NUMBER
WI5646-015OtherLISCENSE NUMBER