Provider Demographics
NPI:1235360017
Name:GREG FELTHOUSEN, DDS, MS, LLC
Entity Type:Organization
Organization Name:GREG FELTHOUSEN, DDS, MS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:FELTHOUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:410-548-1096
Mailing Address - Street 1:304 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-7122
Mailing Address - Country:US
Mailing Address - Phone:410-548-1096
Mailing Address - Fax:410-219-5798
Practice Address - Street 1:304 DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7122
Practice Address - Country:US
Practice Address - Phone:410-548-1096
Practice Address - Fax:410-219-5798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD105111223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty