Provider Demographics
NPI:1245454156
Name:FELLER, JED M (DDS MSD)
Entity type:Individual
Prefix:DR
First Name:JED
Middle Name:M
Last Name:FELLER
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2871 N TENAYA WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0452
Mailing Address - Country:US
Mailing Address - Phone:702-341-8668
Mailing Address - Fax:702-341-7044
Practice Address - Street 1:2871 N TENAYA WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0452
Practice Address - Country:US
Practice Address - Phone:702-341-8668
Practice Address - Fax:702-341-7044
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4343 (S3-65)1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics