Provider Demographics
NPI:1023205176
Name:STANLEY FELLMAN & JEANNE STRATHEARN, D.D.S.
Entity Type:Organization
Organization Name:STANLEY FELLMAN & JEANNE STRATHEARN, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-236-4249
Mailing Address - Street 1:12 N MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1932
Mailing Address - Country:US
Mailing Address - Phone:860-236-4249
Mailing Address - Fax:860-236-3726
Practice Address - Street 1:12 N MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1932
Practice Address - Country:US
Practice Address - Phone:860-236-4249
Practice Address - Fax:860-236-3726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT33851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty