Provider Demographics
NPI:1356125587
Name:FLEMING, BREA NICOLE (DDS)
Entity type:Individual
Prefix:
First Name:BREA
Middle Name:NICOLE
Last Name:FLEMING
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 1:9232 RANDLE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-7725
Mailing Address - Country:US
Mailing Address - Phone:901-828-9393
Mailing Address - Fax:
Practice Address - Street 1:2849 N GERMANTOWN PKWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-8200
Practice Address - Country:US
Practice Address - Phone:901-248-4732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016017981223G0001X
TN125001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice