Provider Demographics
NPI:1659555076
Name:FELLARS, DAVID MAX (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MAX
Last Name:FELLARS
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 1:6244 WOODHAVEN VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6850
Mailing Address - Country:US
Mailing Address - Phone:760-889-8226
Mailing Address - Fax:
Practice Address - Street 1:3607 ALOMA AVE STE 1031
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8856
Practice Address - Country:US
Practice Address - Phone:321-304-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN268851223G0001X
CA517771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice