Provider Demographics
NPI:1447547237
Name:FLEMING, BRENT (DDS)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:
Last Name:FLEMING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 BLACKBURN ST
Mailing Address - Street 2:APT3403
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1588
Mailing Address - Country:US
Mailing Address - Phone:321-917-4790
Mailing Address - Fax:
Practice Address - Street 1:1231 E BELT LINE RD
Practice Address - Street 2:SUITE103
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-3748
Practice Address - Country:US
Practice Address - Phone:972-690-8617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX256561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice