Fletcher, Gordon Earl

Fletcher, Gordon Earl is an individual health care provider with primary practice located at 1904 Hardy St , Hattiesburg MS 39401-4983. He recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Pediatric Dentistry. Dental Providers / General Practice is his primary health care specialty. Fletcher, Gordon Earl can be contacted via phone (601) 583-2250.

Contact Information

Primary practice address
1904 Hardy St Hattiesburg MS 39401-4983
Phone: (601) 583-2250
Fax: (601) 583-2272
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 3268-03 Mississippi
Dental Providers / General Practice 1223G0001X 3515 Louisiana
Dental Providers / Pediatric Dentistry 1223P0221X PEDO3703 Louisiana

Profile Details

NPI number 1255350369
LBN Legal business name Fletcher, Gordon Earl
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 19th, 2006
Last updated Jul 16th, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255350369 NPPES
Louisiana MEDICAID 1835153

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