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NPI Code Detail

MEDICARE: DR. ERIC FLESHER D.M.D.

MEDICARE: DR. ERIC FLESHER D.M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist019-030178IL
2122300000XDentist31915TX

General Provider Information

NPI Number : 1265814990
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERIC FLESHER D.M.D.
Provider Business Mailing Address
First Line : 2717 BOSTWICK ST.
Second Line :
City : ALTON
State : IL
Zip : 62002-5412
Country : US
Telephone Number : 847-721-3532
Fax Number :
Provider Business Practice Location Address
First Line : 1403 N LOOP 336 W STE C
Second Line :
City : CONROE
State : TX
Zip : 77304-3672
Country : US
Telephone Number : 936-539-4867
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2015
Last Update Date : 07/12/2016

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