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Individual

MADELYN LUCILLE FLETCHER-STARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DDS

Contact information

Practice address
8521 GOLF COURSE RD NW STE 116, ALBUQUERQUE, NM 87114-4549
(505) 897-6453
Mailing address
8521 GOLF COURSE RD NW STE 116, ALBUQUERQUE, NM 87114-4549
(505) 897-6453

Taxonomy

Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
47259
CA
1223P0700X
Prosthodontics
Primary
DD4508
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
47259
LICENSE NUMBER
CA
Enumeration date
09/29/2009
Last updated
10/17/2017
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