Provider Demographics
NPI:1780689786
Name:FELD, FRED STEWART (DMD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:STEWART
Last Name:FELD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12331 IMPERIAL DR
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-3924
Mailing Address - Country:US
Mailing Address - Phone:727-393-3394
Mailing Address - Fax:727-394-1514
Practice Address - Street 1:715 49TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-6610
Practice Address - Country:US
Practice Address - Phone:727-321-0368
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL81561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice