Provider Demographics
NPI:1427737758
Name:FLEMING, LYDIA MAE (DDS)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:MAE
Last Name:FLEMING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 2ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:MN
Mailing Address - Zip Code:55932-9732
Mailing Address - Country:US
Mailing Address - Phone:507-876-0127
Mailing Address - Fax:
Practice Address - Street 1:124 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:MN
Practice Address - Zip Code:55932-9732
Practice Address - Country:US
Practice Address - Phone:507-876-0127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND149781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice