Provider Demographics
NPI:1245234186
Name:FELTS, STEVE G (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:G
Last Name:FELTS
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 LOCKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2709
Mailing Address - Country:US
Mailing Address - Phone:336-722-7534
Mailing Address - Fax:336-722-4518
Practice Address - Street 1:140 LOCKLAND AVE
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2709
Practice Address - Country:US
Practice Address - Phone:336-722-7534
Practice Address - Fax:336-722-4518
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC52111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8996244Medicaid