FLEETWOOD DENTAL PROFESSIONAL CORPORATION
NPI 1104091388
Dentist - General Practice in Fleetwood, PA

Q: What is Fleetwood Dental Professional Corporation's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Active since April 28, 2008CLIA 39D2201851 · Waiver

805 N RICHMOND STREET, SUITE 102, FLEETWOOD, PA 19522(610) 944-9771(610) 944-0702 Get Directions Write a Review

NPPES record last updated: December 2, 2019. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Fleetwood Dental Professional Corporation NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FLEETWOOD DENTAL PROFESSIONAL CORPORATION (NPI 1104091388) is a healthcare organization registered as a general practice in Fleetwood, Pennsylvania and active in the NPI registry since April 2008. The organization holds a CLIA Waiver certificate valid through November 23, 2026 and lists Michelle M Lee, Owner, as its authorized official.

NPPES Registry Identity

NPI1104091388

Entity TypeOrganization

Primary Taxonomy1223G0001X

Legal Business NameFLEETWOOD DENTAL PROFESSIONAL CORPORATION

Location Address805 N RICHMOND STREET, SUITE 102Fleetwood, PA 19522

Mailing Address805 N Richmond Street, Suite 102Fleetwood, PA 19522 · (610) 944-9771 · Fax (610) 944-0702

Phone(610) 944-9771

Fax(610) 944-0702

Organization SubpartNo

Authorized OfficialMichelle M LeeOwner · (610) 944-9771

Enumeration DateApril 28, 2008

Last NPPES UpdateDecember 2, 2019

✔ NPI 1104091388 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in PA · DS036286

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

805 N RICHMOND STREET, Fleetwood, PA 19522

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 39D2201851

Fleetwood Dental · Fleetwood, PA

Active · expires Nov 23, 2026

CLIA Number39D2201851

Laboratory TypePractitioner Other

Certificate Effective DateNovember 24, 2024

Certificate Expiration DateNovember 23, 2026

Laboratory DirectorDr. Michelle M. Lee

Laboratory Phone(610) 944-9771

Laboratory LocationFleetwood Dental805 N Richmond St, Suite 102, Fleetwood, PA 19522

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Fleetwood Dental Professional Corporation's NPI number?

The NPI number for Fleetwood Dental Professional Corporation is 1104091388. It was assigned to this organization in the NPPES registry on April 28, 2008.

Where is Fleetwood Dental Professional Corporation located?

Fleetwood Dental Professional Corporation is located at 805 N Richmond Street Suite 102, Fleetwood, PA 19522. The listed phone number is (610) 944-9771.

What is Fleetwood Dental Professional Corporation's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Does Fleetwood Dental Professional Corporation hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 39D2201851) is associated with this NPI, valid through November 23, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Fleetwood Dental Professional Corporation was last updated on December 2, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.