Provider Demographics
NPI:1497323711
Name:FELTEN, NICKOLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICKOLAS
Middle Name:
Last Name:FELTEN
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 1:3750 S RIVER PKWY APT 417
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4745
Mailing Address - Country:US
Mailing Address - Phone:507-696-3303
Mailing Address - Fax:
Practice Address - Street 1:2236 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2448
Practice Address - Country:US
Practice Address - Phone:503-359-5481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD118141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty