Provider Demographics
NPI:1376607341
Name:FELDMAN, NICHOLAS W (DDS,MBA)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:W
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:DDS,MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 W 36TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-5802
Mailing Address - Country:US
Mailing Address - Phone:907-562-0958
Mailing Address - Fax:907-562-6425
Practice Address - Street 1:405 W 36TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5802
Practice Address - Country:US
Practice Address - Phone:907-562-0958
Practice Address - Fax:907-562-6425
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK05591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD0559Medicaid