Active NPI
Robert Edwin Fletcher, D.M.D.
- General Practice Dentistry
- San Antonio, TX
National Provider Identifier
1578878559
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 25864
- Practice address
- 17655 Henderson Pass
Apt 1431
San Antonio, TX 78232 - Phone
- (806) 778-1136
- NPI assigned
- Aug 13, 2010
- Last updated
- May 12, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 25864 | TX | Primary |
Addresses
Primary practice location
17655 Henderson Pass
Apt 1431
San Antonio, TX 78232
Mailing address
17655 Henderson Pass
Apt 1431
San Antonio, TX 78232
Phone (806) 778-1136
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 121513902 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25864 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1281657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1399852800000",
"number": "1578878559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17655 HENDERSON PASS",
"address_2": "APT 1431",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "78232",
"telephone_number": "806-778-1136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17655 HENDERSON PASS",
"address_2": "APT 1431",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "78232",
"telephone_number": "806-778-1136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FLETCHER",
"first_name": "ROBERT",
"middle_name": "EDWIN",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-08-13",
"last_updated": "2014-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "25864",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "121513902",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.