Provider Demographics
NPI:1679655963
Name:FLETCHER, JACK M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:M
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 1:539 TURTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5632
Mailing Address - Country:US
Mailing Address - Phone:615-371-3857
Mailing Address - Fax:615-832-5410
Practice Address - Street 1:5505 EDMONDSON PIKE
Practice Address - Street 2:SUITE 201
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-5869
Practice Address - Country:US
Practice Address - Phone:615-331-0402
Practice Address - Fax:615-832-5410
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS2364122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist