Provider Demographics
NPI:1366332504
Name:FLESHREN, CALLIE (DMD)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:FLESHREN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2329 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-2023
Mailing Address - Country:US
Mailing Address - Phone:618-910-1266
Mailing Address - Fax:
Practice Address - Street 1:2102 W RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-1973
Practice Address - Country:US
Practice Address - Phone:618-283-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0361481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice