Provider Demographics
NPI:1710216494
Name:FLEYSH, KLARA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KLARA
Middle Name:
Last Name:FLEYSH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 E CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-1910
Mailing Address - Country:US
Mailing Address - Phone:414-063-0950
Mailing Address - Fax:414-963-0950
Practice Address - Street 1:1714 E CAPITOL DR
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-1910
Practice Address - Country:US
Practice Address - Phone:414-063-0950
Practice Address - Fax:414-963-0950
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4839-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33736600Medicaid