Provider Demographics
NPI:1992870562
Name:CHISHOLM, FLEMING C (DMD)
Entity type:Individual
Prefix:DR
First Name:FLEMING
Middle Name:C
Last Name:CHISHOLM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5186 BOWLING GREEN RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42164-9671
Mailing Address - Country:US
Mailing Address - Phone:270-622-5178
Mailing Address - Fax:270-622-7086
Practice Address - Street 1:5186 BOWLING GREEN RD
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42164-9671
Practice Address - Country:US
Practice Address - Phone:270-622-5178
Practice Address - Fax:270-622-7086
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60048709Medicaid