MEDICARE: DR. JOHN MACFEETERS D.M.D

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	390200000X	Student in an Organized Health Care Education/Training Program		NJ
2	122300000X	Dentist	22DI02616800	NJ

General Provider Information

NPI Number	:	1235526179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MACFEETERS D.M.D

Provider Business Mailing Address
First Line	:	410 N BROADWAY
Second Line	:
City	:	PITMAN
State	:	NJ
Zip	:	08071-1047
Country	:	US
Telephone Number	:	856-589-3803
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 N BROADWAY
Second Line	:
City	:	PITMAN
State	:	NJ
Zip	:	08071-1047
Country	:	US
Telephone Number	:	856-589-3803
Fax Number	:

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

Provider Enumeration Date	:	04/17/2015
Last Update Date	:	04/16/2016

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