Provider Demographics
NPI:1245785930
Name:FELDMAN, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 S FREMONT AVE
Mailing Address - Street 2:#1430
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2068
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5101 E BUSCH BLVD
Practice Address - Street 2:#13
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-5380
Practice Address - Country:US
Practice Address - Phone:813-988-1167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22115122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist