Provider Demographics
NPI:1093444838
Name:FELDMAN, GEORGE JAY
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:JAY
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:GEORGE
Other - Middle Name:J
Other - Last Name:FELDMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1312 WRENFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:VILLANOVA
Mailing Address - State:PA
Mailing Address - Zip Code:19085-2067
Mailing Address - Country:US
Mailing Address - Phone:610-213-6023
Mailing Address - Fax:
Practice Address - Street 1:1312 WRENFIELD WAY
Practice Address - Street 2:
Practice Address - City:VILLANOVA
Practice Address - State:PA
Practice Address - Zip Code:19085-2067
Practice Address - Country:US
Practice Address - Phone:610-213-6023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023783L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice