Provider Demographics
NPI:1376028423
Name:FEUILLERAT, D.D.S., S.C.
Entity Type:Organization
Organization Name:FEUILLERAT, D.D.S., S.C.
Other - Org Name:SCENIC BLUFFS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:FEUILLERAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-953-0499
Mailing Address - Street 1:1435 N. ACRES RD. SUITE 102
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:WI
Mailing Address - Zip Code:54021
Mailing Address - Country:US
Mailing Address - Phone:715-953-0499
Mailing Address - Fax:
Practice Address - Street 1:1435 N. ACRES RD. SUITE 102
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:WI
Practice Address - Zip Code:54021
Practice Address - Country:US
Practice Address - Phone:715-953-0499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-25
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental