Provider Demographics
NPI:1174525448
Name:FLETCHER, JOHN GRANT (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GRANT
Last Name:FLETCHER
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 1:2600 E SOUTHERN AVE
Mailing Address - Street 2:STE B1
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7745
Mailing Address - Country:US
Mailing Address - Phone:480-839-4550
Mailing Address - Fax:480-897-8407
Practice Address - Street 1:2600 E SOUTHERN AVE
Practice Address - Street 2:STE B1
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7745
Practice Address - Country:US
Practice Address - Phone:480-839-4550
Practice Address - Fax:480-897-8407
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ 48011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice