Provider Demographics
NPI:1558357681
Name:FEINBERG, JOEL B
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:B
Last Name:FEINBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 14TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-4622
Mailing Address - Country:US
Mailing Address - Phone:970-392-0152
Mailing Address - Fax:
Practice Address - Street 1:4942 PAWNEE DR
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-9311
Practice Address - Country:US
Practice Address - Phone:970-330-8696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COHD194122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN