Provider Demographics
NPI:1376864702
Name:FEHRING, CANDICE LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:LEE
Last Name:FEHRING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CANDICE
Other - Middle Name:LEE
Other - Last Name:BALOGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:24834 LORAIN RD
Mailing Address - Street 2:NORTH OLMSTED
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-2048
Mailing Address - Country:US
Mailing Address - Phone:440-925-5255
Mailing Address - Fax:
Practice Address - Street 1:24834 LORAIN RD
Practice Address - Street 2:NORTH OLMSTED
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-2048
Practice Address - Country:US
Practice Address - Phone:440-925-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH29141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice