Healthcare Provider Details

I. General information

NPI: 1649322652
Provider Name (Legal Business Name): COURTNEY W FLEMING D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 01/11/2023
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 ALLENTOWN RD
LIMA OH
45805-1845
US

IV. Provider business mailing address

1702 ALLENTOWN RD
LIMA OH
45805-1845
US

V. Phone/Fax

Practice location:
  • Phone: 419-222-0693
  • Fax: 419-879-6478
Mailing address:
  • Phone: 419-222-0693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.021749
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21749
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: