Provider Demographics
NPI:1043342983
Name:FEISTHAMEL, MARLENE K (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:K
Last Name:FEISTHAMEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5469 S STATE HIGHWAY FF
Mailing Address - Street 2:
Mailing Address - City:BATTLEFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65619-9825
Mailing Address - Country:US
Mailing Address - Phone:417-447-5180
Mailing Address - Fax:417-447-1509
Practice Address - Street 1:5469 S STATE HIGHWAY FF
Practice Address - Street 2:
Practice Address - City:BATTLEFIELD
Practice Address - State:MO
Practice Address - Zip Code:65619-9825
Practice Address - Country:US
Practice Address - Phone:417-447-5180
Practice Address - Fax:417-447-1509
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO015614122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist