Provider Demographics
NPI:1750468054
Name:FEIDER, BRUCE A (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:A
Last Name:FEIDER
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 1:2926 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-6706
Mailing Address - Country:US
Mailing Address - Phone:920-452-1031
Mailing Address - Fax:920-458-2326
Practice Address - Street 1:2926 S 12TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-6706
Practice Address - Country:US
Practice Address - Phone:920-452-1031
Practice Address - Fax:920-458-2326
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice