Provider Demographics
NPI:1679642169
Name:FELLER, PAUL R (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:FELLER
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 1:250 N FAIRGROUNDS RD STE 4
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-4201
Mailing Address - Country:US
Mailing Address - Phone:435-637-4660
Mailing Address - Fax:435-637-4690
Practice Address - Street 1:250 N FAIRGROUNDS RD STE 4
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-4201
Practice Address - Country:US
Practice Address - Phone:435-637-4660
Practice Address - Fax:435-637-4690
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTUT139463122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist