Provider Demographics
NPI:1609989854
Name:FELDMAN, BLAIR (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14967 W BELL RD STE 150
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-3223
Mailing Address - Country:US
Mailing Address - Phone:623-544-1334
Mailing Address - Fax:
Practice Address - Street 1:14967 W BELL RD STE 150
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3223
Practice Address - Country:US
Practice Address - Phone:623-544-1334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD54541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD5454OtherAZ DENTAL LICENSE