Provider Demographics
NPI:1235109349
Name:FELSENFELD, ROBERT BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRUCE
Last Name:FELSENFELD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:BRUCE
Other - Last Name:FELSENFELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:22731 NEWMAN ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2034
Mailing Address - Country:US
Mailing Address - Phone:313-562-1515
Mailing Address - Fax:313-562-7439
Practice Address - Street 1:22731 NEWMAN ST
Practice Address - Street 2:SUITE 240
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3852
Practice Address - Country:US
Practice Address - Phone:313-562-1515
Practice Address - Fax:313-562-7439
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRF0134491223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5826234697Medicare PIN