MEDICARE: DR. AUDRA ANN FELDHAUS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2016016433	MO

General Provider Information

NPI Number	:	1154770121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUDRA ANN FELDHAUS DDS

Provider Business Mailing Address
First Line	:	415 E 69 HIGHWAY
Second Line	:
City	:	CLAYCOMO
State	:	MO
Zip	:	64119-3118
Country	:	US
Telephone Number	:	816-454-0377
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 E US HIGHWAY 69
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-3118
Country	:	US
Telephone Number	:	816-454-0377
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2016
Last Update Date	:	06/09/2016

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