Provider Demographics
NPI:1295257384
Name:GARY R FELDMAN DDS MD PS
Entity type:Organization
Organization Name:GARY R FELDMAN DDS MD PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MD PS
Authorized Official - Phone:206-215-2088
Mailing Address - Street 1:1221 MADISON ST STE 1116
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3536
Mailing Address - Country:US
Mailing Address - Phone:206-215-2088
Mailing Address - Fax:206-215-2087
Practice Address - Street 1:1221 MADISON ST STE 1116
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3536
Practice Address - Country:US
Practice Address - Phone:206-215-2088
Practice Address - Fax:206-215-2087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA17630261Q00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty