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General NPI Number Information
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NPI Number | 1104263193
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Entity Type | Individual
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Provider Name | SCOTT G. FLEMING DDS
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Gender | Male
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Dates
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Enumeration Date | 05/30/2013
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 836 W WELLINGTON AVE
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City | CHICAGO
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State | IL
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Zip | 60657-5147
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Country | US
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Telephone | 773-975-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 4430 N RICHMOND ST
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City | CHICAGO
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State | IL
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Zip | 60625-3824
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Country | US
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Telephone | 630-222-5065
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019029423
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 019.029423
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License Number State | IL
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