Provider Demographics
NPI:1922021781
Name:FLETCHER, DESIREE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:A
Last Name:FLETCHER
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 1:1050 140TH AVE NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2972
Mailing Address - Country:US
Mailing Address - Phone:425-746-7410
Mailing Address - Fax:425-641-3520
Practice Address - Street 1:1050 140TH AVE NE
Practice Address - Street 2:SUITE A
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2972
Practice Address - Country:US
Practice Address - Phone:425-746-7410
Practice Address - Fax:425-641-3520
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA76491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice