Provider Demographics
NPI:1629289129
Name:FELDER MCKELVEY, LORETTA KAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:LORETTA
Middle Name:KAY
Last Name:FELDER MCKELVEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LORETTA
Other - Middle Name:KAY
Other - Last Name:FELDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 50664
Mailing Address - Street 2:2329 DEVINE STREET
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29250
Mailing Address - Country:US
Mailing Address - Phone:803-252-8101
Mailing Address - Fax:803-779-7721
Practice Address - Street 1:2329 DEVINE STREET
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29250
Practice Address - Country:US
Practice Address - Phone:803-252-8101
Practice Address - Fax:803-779-7721
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC2642122300000X
GADN013211122300000X
VA0401411265122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZZ2642Medicaid