Provider Demographics
NPI:1013918648
Name:FLEMING, JOHN CARL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CARL
Last Name:FLEMING
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 CHAMPAGNE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-3165
Mailing Address - Country:US
Mailing Address - Phone:719-264-6094
Mailing Address - Fax:
Practice Address - Street 1:827 CHEYENNE MEADOWS RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4929
Practice Address - Country:US
Practice Address - Phone:719-579-8799
Practice Address - Fax:719-579-6654
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO77831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice