Provider Demographics
NPI:1730279183
Name:FLETCHER, JAMES L
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 W MUSKEGON DR., SUITE 1
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-3068
Mailing Address - Country:US
Mailing Address - Phone:317-462-6560
Mailing Address - Fax:317-462-7476
Practice Address - Street 1:86 W MUSKEGON DR., SUITE 1
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-3068
Practice Address - Country:US
Practice Address - Phone:317-462-6560
Practice Address - Fax:317-462-7476
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120087851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice