Provider Demographics
NPI:1235147372
Name:FELT, JEREMY MERRILL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:MERRILL
Last Name:FELT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2779 W. 4000 S. SUITE 102
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-9429
Mailing Address - Country:US
Mailing Address - Phone:801-776-4462
Mailing Address - Fax:
Practice Address - Street 1:2779 W. 4000 S. SUITE 102
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-9429
Practice Address - Country:US
Practice Address - Phone:801-774-9354
Practice Address - Fax:801-774-6430
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5333398-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice