Provider Demographics
NPI:1417336009
Name:JORDAN W. FELKNER, DDS, PLLC
Entity Type:Organization
Organization Name:JORDAN W. FELKNER, DDS, PLLC
Other - Org Name:LAMPASAS DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:FELKNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-556-2090
Mailing Address - Street 1:1206 CENTRAL TEXAS EXPY
Mailing Address - Street 2:
Mailing Address - City:LAMPASAS
Mailing Address - State:TX
Mailing Address - Zip Code:76550-3321
Mailing Address - Country:US
Mailing Address - Phone:512-556-2090
Mailing Address - Fax:512-556-8964
Practice Address - Street 1:1206 CENTRAL TEXAS EXPY
Practice Address - Street 2:
Practice Address - City:LAMPASAS
Practice Address - State:TX
Practice Address - Zip Code:76550-3321
Practice Address - Country:US
Practice Address - Phone:512-556-2090
Practice Address - Fax:512-556-8964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX131031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090277702Medicaid