Provider Demographics
NPI:1609968940
Name:RODNEY L FEASTER DDS PC
Entity Type:Organization
Organization Name:RODNEY L FEASTER DDS PC
Other - Org Name:FAMILY DENTAL HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FEASTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-235-5422
Mailing Address - Street 1:G4007 W COURT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3560
Mailing Address - Country:US
Mailing Address - Phone:810-235-5422
Mailing Address - Fax:810-232-7473
Practice Address - Street 1:G4007 W COURT ST
Practice Address - Street 2:SUITE A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3560
Practice Address - Country:US
Practice Address - Phone:810-235-5422
Practice Address - Fax:810-232-7473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI140721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1658670Medicaid