Provider Demographics
NPI: | 1134395833 |
---|---|
Name: | DENTAL OFFICES OF GEORGE D FELDER |
Entity type: | Organization |
Organization Name: | DENTAL OFFICES OF GEORGE D FELDER |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT/VICE PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | GEORGE |
Authorized Official - Middle Name: | D |
Authorized Official - Last Name: | FELDER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DMD |
Authorized Official - Phone: | 412-882-1700 |
Mailing Address - Street 1: | 5208 CLAIRTON BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | PITTSBURGH |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 15236-2711 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 412-882-1700 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 5208 CLAIRTON BLVD |
Practice Address - Street 2: | |
Practice Address - City: | PITTSBURGH |
Practice Address - State: | PA |
Practice Address - Zip Code: | 15236-2711 |
Practice Address - Country: | US |
Practice Address - Phone: | 412-882-1700 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-05-02 |
Last Update Date: | 2008-05-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | DS021351L | 122300000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 122300000X | Dental Providers | Dentist | Group - Single Specialty |