Provider Demographics
NPI:1104931534
Name:FLETCHER, SIDNEY TRUMAN (DDS)
Entity type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:TRUMAN
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 N GERMANTOWN PKWY
Mailing Address - Street 2:STE. 105
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6692
Mailing Address - Country:US
Mailing Address - Phone:901-249-2048
Mailing Address - Fax:901-249-2059
Practice Address - Street 1:465 N GERMANTOWN PKWY
Practice Address - Street 2:STE. 105
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6692
Practice Address - Country:US
Practice Address - Phone:901-249-2048
Practice Address - Fax:901-249-2059
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNO 126111223G0001X
TNDS94241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice