Provider Demographics
NPI:1215824578
Name:FEDER, INGRID EDENA (DMD)
Entity type:Individual
Prefix:DR
First Name:INGRID
Middle Name:EDENA
Last Name:FEDER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8424 DAY ST
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-3253
Mailing Address - Country:US
Mailing Address - Phone:773-370-0335
Mailing Address - Fax:
Practice Address - Street 1:2211 E VALLEY VISTA WAY
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-5636
Practice Address - Country:US
Practice Address - Phone:801-377-0037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14223868-99261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty