Provider Demographics
NPI:1982909412
Name:WALTER G. FLETCHER, D.D.S.
Entity Type:Organization
Organization Name:WALTER G. FLETCHER, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:352-732-5646
Mailing Address - Street 1:2509 S.E. 17TH STREET
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471
Mailing Address - Country:US
Mailing Address - Phone:352-732-5646
Mailing Address - Fax:352-732-0242
Practice Address - Street 1:2509 S.E. 17TH STREET
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471
Practice Address - Country:US
Practice Address - Phone:352-732-5646
Practice Address - Fax:352-732-0242
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALTER G. FLETCHER, D.D.S., P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL000-54911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty