Provider Demographics
NPI:1336357748
Name:FLEIGEL, JEFFREY DEE III (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DEE
Last Name:FLEIGEL
Suffix:III
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8602 SILVER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8145
Mailing Address - Country:US
Mailing Address - Phone:352-362-5761
Mailing Address - Fax:
Practice Address - Street 1:7200 N MOPAC EXPY
Practice Address - Street 2:#215
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3069
Practice Address - Country:US
Practice Address - Phone:512-345-6081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN172001223P0700X, 122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006240700Medicaid