Provider Demographics
NPI:1528248135
Name:FLETCHER FAMILY DENTISTRY
Entity type:Organization
Organization Name:FLETCHER FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:828-654-7450
Mailing Address - Street 1:235 ST JOHN ROAD
Mailing Address - Street 2:SUITE K
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-8335
Mailing Address - Country:US
Mailing Address - Phone:828-654-7450
Mailing Address - Fax:828-654-8665
Practice Address - Street 1:235 ST JOHN ROAD
Practice Address - Street 2:SUITE K
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-8335
Practice Address - Country:US
Practice Address - Phone:828-654-7450
Practice Address - Fax:828-654-8665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC75821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty