Provider Demographics
NPI:1639234271
Name:FLEACE, ANGELA LEA (DMD)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:LEA
Last Name:FLEACE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 CHARLEVOIX COURT
Mailing Address - Street 2:
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-9761
Mailing Address - Country:US
Mailing Address - Phone:812-941-0128
Mailing Address - Fax:
Practice Address - Street 1:360 NEW ALBANY PLZ
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4654
Practice Address - Country:US
Practice Address - Phone:812-945-4040
Practice Address - Fax:913-752-9116
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010404122300000X
KY9160122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200376150Medicaid