Provider Demographics
NPI:1942397609
Name:FLEMMER, WARREN CLYDE (DDS)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:CLYDE
Last Name:FLEMMER
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 1:228 PULASKI STREET
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464
Mailing Address - Country:US
Mailing Address - Phone:931-762-3901
Mailing Address - Fax:931-762-3991
Practice Address - Street 1:228 PULASKI STREET
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464
Practice Address - Country:US
Practice Address - Phone:931-762-3901
Practice Address - Fax:931-762-3991
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0029121223G0001X
TN29121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
0017882OtherBLUECROSS BLUESHIELD
TN0017882OtherBCBST - ID #