MEDICARE: MICHAEL LEE FLEMING DMD

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	1223G0001X	General Practice Dentistry	103825	CA

General Provider Information

NPI Number	:	1992366629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL LEE FLEMING DMD

Provider Business Mailing Address
First Line	:	6584 HIGH KNOLL RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-5427
Country	:	US
Telephone Number	:	858-361-1575
Fax Number	:

Provider Business Practice Location Address
First Line	:	1857 CABLE ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92107-3122
Country	:	US
Telephone Number	:	619-224-3391
Fax Number	:

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

Provider Enumeration Date	:	06/24/2019
Last Update Date	:	06/24/2019

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