Individual
DR. JENELLE LOUISE FLEAGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
5509 BENDT DR STE 302, RAPID CITY, SD 57702-9460
(605) 939-7992
Mailing address
5509 BENDT DR STE 302, RAPID CITY, SD 57702-9460
(605) 939-7992
(605) 534-1599
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
30-023733
OH
1223P0221X
Pediatric Dentistry
D1324
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0098381
—
OH
Enumeration date
07/10/2012
Last updated
08/18/2021
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