Provider Demographics
NPI:1750470951
Name:FLEMING FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:FLEMING FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INS COORD
Authorized Official - Prefix:
Authorized Official - First Name:TANJA
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:WODA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-263-4040
Mailing Address - Street 1:3674 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214
Mailing Address - Country:US
Mailing Address - Phone:614-263-4040
Mailing Address - Fax:614-267-7075
Practice Address - Street 1:3674 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214
Practice Address - Country:US
Practice Address - Phone:614-263-4040
Practice Address - Fax:614-267-7075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21749122300000X
OH22026122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty