Provider Demographics
NPI:1295875912
Name:FLETCHER, ROBERT LEE III (DMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:FLETCHER
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:LEE
Other - Middle Name:
Other - Last Name:FLETCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1951 J L TODD DR
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-5015
Mailing Address - Country:US
Mailing Address - Phone:706-234-5353
Mailing Address - Fax:706-234-0762
Practice Address - Street 1:1951 J L TODD DR
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-5015
Practice Address - Country:US
Practice Address - Phone:706-234-5353
Practice Address - Fax:706-234-0762
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0128961223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics