Provider Demographics
NPI:1821140468
Name:FLEMING, DAWN EILENNE (DDS)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:EILENNE
Last Name:FLEMING
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 1:710 RIATA CT.
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167
Mailing Address - Country:US
Mailing Address - Phone:517-303-1777
Mailing Address - Fax:517-882-5808
Practice Address - Street 1:6001 JACKSON SQUARE BLVD., STE. 1001
Practice Address - Street 2:
Practice Address - City:LAVERGNE
Practice Address - State:TN
Practice Address - Zip Code:37086
Practice Address - Country:US
Practice Address - Phone:615-280-2667
Practice Address - Fax:517-882-5808
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010160711223G0001X
TN10659122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4445960Medicaid