Provider Demographics
NPI:1558744664
Name:FELLER, LAURA REARDON (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:REARDON
Last Name:FELLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 W PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-2611
Mailing Address - Country:US
Mailing Address - Phone:610-269-0489
Mailing Address - Fax:
Practice Address - Street 1:35 W PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-2611
Practice Address - Country:US
Practice Address - Phone:610-269-0489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039974122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist