Provider Demographics
NPI:1114131158
Name:FEELEY, JOHN PAUL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:FEELEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6363 W 120TH AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-0300
Mailing Address - Country:US
Mailing Address - Phone:303-635-0100
Mailing Address - Fax:303-635-0300
Practice Address - Street 1:6363 W 120TH AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-0300
Practice Address - Country:US
Practice Address - Phone:303-635-0100
Practice Address - Fax:303-635-0300
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6964122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist