Healthcare Provider Details

I. General information

NPI: 1982998506
Provider Name (Legal Business Name): PAUL NEIL FLUCKIGER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 CABOT ST
BEVERLY MA
01915-3390
US

IV. Provider business mailing address

1 MAIN ST
PEABODY MA
01960-5509
US

V. Phone/Fax

Practice location:
  • Phone: 617-651-1186
  • Fax:
Mailing address:
  • Phone: 617-532-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN1855678
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: