Provider Demographics
NPI:1780694596
Name:FELGENHAUER, DAVID JOHN (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:FELGENHAUER
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 1:1999 75TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-2664
Mailing Address - Country:US
Mailing Address - Phone:630-910-3200
Mailing Address - Fax:
Practice Address - Street 1:1999 75TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2664
Practice Address - Country:US
Practice Address - Phone:630-910-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery