Provider Demographics
NPI:1417485806
Name:FELKNER, JUSTIN WYATT (DDS)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:WYATT
Last Name:FELKNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7733 LOUIS PASTEUR DR APT 229
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3462
Mailing Address - Country:US
Mailing Address - Phone:512-925-4751
Mailing Address - Fax:
Practice Address - Street 1:1707 W CHARLESTON BLVD STE 290
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2353
Practice Address - Country:US
Practice Address - Phone:702-671-5134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-30
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program