MEDICARE: CLAIRE MARIE FLECKLES RDHAP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	RDHAP42	CA

General Provider Information

NPI Number	:	1508929878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAIRE MARIE FLECKLES RDHAP

Provider Business Mailing Address
First Line	:	1271 WASHINGTON AVE
Second Line	:	810
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-3646
Country	:	US
Telephone Number	:	510-228-5804
Fax Number	:	510-227-5804

Provider Business Practice Location Address
First Line	:	1271 WASHINGTON AVE
Second Line	:	810
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-3646
Country	:	US
Telephone Number	:	510-227-5804
Fax Number	:	510-227-5804

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	02/13/2013

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