Provider Demographics
NPI:1881017630
Name:RICHARD E FELDHAKE,DMD,PC
Entity Type:Organization
Organization Name:RICHARD E FELDHAKE,DMD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:FELDHAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:623-931-8898
Mailing Address - Street 1:5310 W THUNDERBIRD RD
Mailing Address - Street 2:SUIT 111
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4706
Mailing Address - Country:US
Mailing Address - Phone:623-931-8898
Mailing Address - Fax:623-930-1182
Practice Address - Street 1:5310 W THUNDERBIRD RD
Practice Address - Street 2:SUIT 111
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4706
Practice Address - Country:US
Practice Address - Phone:623-931-8898
Practice Address - Fax:623-930-1182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty