Provider Demographics
NPI:1184870024
Name:FLETCHER, JEFFRY DEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFRY
Middle Name:DEAN
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 BROADWAY E
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-5023
Mailing Address - Country:US
Mailing Address - Phone:206-757-2898
Mailing Address - Fax:
Practice Address - Street 1:2902 164TH ST SW
Practice Address - Street 2:SUITE C-1
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-3201
Practice Address - Country:US
Practice Address - Phone:425-329-7756
Practice Address - Fax:425-741-9711
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603169171223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice