Provider Demographics
NPI:1417946948
Name:FELIX, ERIC IAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:IAN
Last Name:FELIX
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 1:628 BAYARD RD
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-2505
Mailing Address - Country:US
Mailing Address - Phone:610-444-1331
Mailing Address - Fax:
Practice Address - Street 1:519 BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-9304
Practice Address - Country:US
Practice Address - Phone:610-388-2131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030525-L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017937370001Medicaid