Provider Demographics
NPI:1497127708
Name:FELDMAN, CRAIG (DMD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:FELDMAN
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 1:1330 BOYLSTON ST
Mailing Address - Street 2:APT. 1308
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-4229
Mailing Address - Country:US
Mailing Address - Phone:917-678-0750
Mailing Address - Fax:
Practice Address - Street 1:4705 44TH STREET SUITE A2
Practice Address - Street 2:THE SMILIST DENTAL
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377
Practice Address - Country:US
Practice Address - Phone:718-215-0812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0534661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics