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General NPI Number Information
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NPI Number | 1700179066
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Entity Type | Organization
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Legal Business Name | KEVIN L FLEMING, DDS A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/19/2011
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Last Update Date | 06/06/2016
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Provider Practice Location Address
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Address Line | 828 S FAIRMONT AVE
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City | LODI
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State | CA
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Zip | 95240-5117
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Country | US
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Telephone | 209-369-8218
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Fax | 209-368-2102
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Provider Business Mailing Address
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Address Line | 828 S FAIRMONT AVE
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City | LODI
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State | CA
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Zip | 95240-5117
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Country | US
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Telephone | 209-369-8218
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Fax | 209-368-2102
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN L FLEMING
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Credential | DDS
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Telephone | 209-369-8218
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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 | 40587
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License Number State | CA
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