Provider Demographics
NPI:1396992350
Name:FELDMAN, MARK (DDS)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634
Mailing Address - Country:US
Mailing Address - Phone:512-642-4106
Mailing Address - Fax:512-410-3015
Practice Address - Street 1:208 MAIN ST
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634
Practice Address - Country:US
Practice Address - Phone:512-642-4106
Practice Address - Fax:512-410-3015
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX191171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice