Provider Demographics
NPI:1629155494
Name:FLETCHER, CHAD T (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:T
Last Name:FLETCHER
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 1:1110 N BUCKNER BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-3498
Mailing Address - Country:US
Mailing Address - Phone:214-328-9173
Mailing Address - Fax:
Practice Address - Street 1:1110 N BUCKNER BLVD STE 102
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3498
Practice Address - Country:US
Practice Address - Phone:214-328-9173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX197151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice