Healthcare Provider Details

I. General information

NPI: 1972583771
Provider Name (Legal Business Name): PATRICK A FLEEGE DDS MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3621 29TH AVE W
SEATTLE WA
98199-1746
US

IV. Provider business mailing address

P O BOX 99654
SEATTLE WA
98139-0654
US

V. Phone/Fax

Practice location:
  • Phone: 206-282-2285
  • Fax:
Mailing address:
  • Phone: 206-282-2285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberPE00003930
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: