Provider Demographics
NPI:1881059194
Name:CARL A FEGHALI DDS PC
Entity type:Organization
Organization Name:CARL A FEGHALI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:A
Authorized Official - Last Name:FEGHALI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-245-9546
Mailing Address - Street 1:1120 WELLINGTON AVE.
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6131
Mailing Address - Country:US
Mailing Address - Phone:970-245-9546
Mailing Address - Fax:970-243-2225
Practice Address - Street 1:1120 WELLINGTON AVE.
Practice Address - Street 2:SUITE 203
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6131
Practice Address - Country:US
Practice Address - Phone:970-245-9546
Practice Address - Fax:970-243-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO64821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO7522180001Medicare NSC