Provider Demographics
NPI:1699823138
Name:FLETCHER, GREGORY LANCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LANCE
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 1:42169 CALLE CORRIENTE
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-8712
Mailing Address - Country:US
Mailing Address - Phone:951-677-3441
Mailing Address - Fax:951-696-5257
Practice Address - Street 1:41690 ENTERPRISE CIR N STE 114
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5617
Practice Address - Country:US
Practice Address - Phone:951-296-3550
Practice Address - Fax:951-296-3553
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA325521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice