Provider Demographics
NPI:1366454134
Name:FELDMAN, DONALD L (DMD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:L
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-1928
Mailing Address - Country:US
Mailing Address - Phone:617-569-7300
Mailing Address - Fax:617-569-8689
Practice Address - Street 1:3 MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1928
Practice Address - Country:US
Practice Address - Phone:617-569-7300
Practice Address - Fax:617-569-8689
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110681223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0257087Medicaid
MA00004OtherDELTA
MAX10244OtherBXBS