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General NPI Number Information
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NPI Number | 1255350369
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Entity Type | Individual
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Provider Name | GORDON EARL FLETCHER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 07/16/2013
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Provider Practice Location Address
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Address Line | 1904 HARDY ST
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City | HATTIESBURG
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State | MS
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Zip | 39401-4983
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Country | US
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Telephone | 601-583-2250
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Fax | 601-583-2272
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Provider Business Mailing Address
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Address Line | 3737 S CLAIBORNE AVE
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City | NEW ORLEANS
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State | LA
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Zip | 70125-4603
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Country | US
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Telephone | 504-289-4602
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3268-03
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3515
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | PEDO3703
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License Number State | LA
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