Provider Demographics
NPI:1598990897
Name:FEEHAN, JOHNATHAN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHNATHAN
Middle Name:J
Last Name:FEEHAN
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 1:2909 19TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61244-5019
Mailing Address - Country:US
Mailing Address - Phone:309-796-2251
Mailing Address - Fax:309-796-2274
Practice Address - Street 1:2909 19TH ST
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-5019
Practice Address - Country:US
Practice Address - Phone:309-796-2251
Practice Address - Fax:309-796-2274
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-16
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist