Healthcare Provider Details

I. General information

NPI: 1316162613
Provider Name (Legal Business Name): CARL ROGER FLESER D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 N STATE ROUTE 61
SUNBURY OH
43074-9509
US

IV. Provider business mailing address

1530 N STATE ROUTE 61
SUNBURY OH
43074-9509
US

V. Phone/Fax

Practice location:
  • Phone: 800-222-8207
  • Fax: 740-965-9560
Mailing address:
  • Phone: 800-222-8207
  • Fax: 740-965-9560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number30018756
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: