Provider Demographics
NPI:1619017712
Name:FEIEREISEN, ERIC G (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:G
Last Name:FEIEREISEN
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:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53527-0147
Mailing Address - Country:US
Mailing Address - Phone:608-846-3302
Mailing Address - Fax:
Practice Address - Street 1:502 NELSON CT
Practice Address - Street 2:
Practice Address - City:DE FOREST
Practice Address - State:WI
Practice Address - Zip Code:53532-1267
Practice Address - Country:US
Practice Address - Phone:608-846-3302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5225122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist