Provider Demographics
NPI:1679761902
Name:FELLERS, PAUL HOKE III (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:HOKE
Last Name:FELLERS
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N SECTION STREET
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532
Mailing Address - Country:US
Mailing Address - Phone:251-928-3030
Mailing Address - Fax:251-928-2455
Practice Address - Street 1:24208 US HIGHWAY 98
Practice Address - Street 2:SUITE C
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3466
Practice Address - Country:US
Practice Address - Phone:251-928-3030
Practice Address - Fax:251-928-2455
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL52921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009990685Medicaid