Provider Demographics
NPI:1386766350
Name:FLETCHER, ANDREW R (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:R
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 1:400 E ORANGEBURG AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5365
Mailing Address - Country:US
Mailing Address - Phone:209-524-7347
Mailing Address - Fax:209-524-5099
Practice Address - Street 1:400 E ORANGEBURG AVE STE 5
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5365
Practice Address - Country:US
Practice Address - Phone:209-524-7347
Practice Address - Fax:209-524-5099
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA430071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice