Provider Demographics
NPI:1770815953
Name:FELDKAMP III, IRVING MOORE (DDS)
Entity Type:Individual
Prefix:DR
First Name:IRVING
Middle Name:MOORE
Last Name:FELDKAMP III
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 1:164 W HOSPITALITY LN STE 14
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3329
Mailing Address - Country:US
Mailing Address - Phone:909-888-6919
Mailing Address - Fax:909-888-0468
Practice Address - Street 1:164 W HOSPITALITY LN STE 14
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3329
Practice Address - Country:US
Practice Address - Phone:909-888-6919
Practice Address - Fax:909-888-0468
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA219851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice