Provider Demographics
NPI:1295213239
Name:FELDKAMP CAL SELECT DENTAL GROUP, INC.
Entity Type:Organization
Organization Name:FELDKAMP CAL SELECT DENTAL GROUP, INC.
Other - Org Name:CAL SELECT DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IRVING
Authorized Official - Middle Name:MOORE
Authorized Official - Last Name:FELDKAMP
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-723-1088
Mailing Address - Street 1:PO BOX 10669
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423-0669
Mailing Address - Country:US
Mailing Address - Phone:909-723-1088
Mailing Address - Fax:
Practice Address - Street 1:164 W HOSPITALITY LN # 107
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3316
Practice Address - Country:US
Practice Address - Phone:909-453-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA219851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty