Healthcare Provider Details

I. General information

NPI: 1336357748
Provider Name (Legal Business Name): JEFFREY DEE FLEIGEL III D.M.D, M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 N MOPAC EXPY #215
AUSTIN TX
78731-3069
US

IV. Provider business mailing address

8602 SILVER RIDGE DR
AUSTIN TX
78759-8145
US

V. Phone/Fax

Practice location:
  • Phone: 512-345-6081
  • Fax:
Mailing address:
  • Phone: 352-362-5761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN17200
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN17200
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN17200
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: