Provider Demographics
NPI:1588303192
Name:FLEISCHHACKER, DEVYN (DDS)
Entity type:Individual
Prefix:DR
First Name:DEVYN
Middle Name:
Last Name:FLEISCHHACKER
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 1:25 S OYSTER BAY RD
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-5002
Mailing Address - Country:US
Mailing Address - Phone:516-365-5439
Mailing Address - Fax:
Practice Address - Street 1:1476 DEER PARK AVE STE 1200
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-1200
Practice Address - Country:US
Practice Address - Phone:631-254-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0442000449122300000X
390200000X
NY0642181223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program