MEDICARE: DR. JOHN FRED FELTON 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	1223P0300X	Periodontics	8062	MD

General Provider Information

NPI Number	:	1457475774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN FRED FELTON DDS

Provider Business Mailing Address
First Line	:	6 CHESTNUT CT
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-1441
Country	:	US
Telephone Number	:	410-455-9893
Fax Number	:	410-455-5380

Provider Business Practice Location Address
First Line	:	606 FREDERICK RD
Second Line	:	SUITE 1B
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-4625
Country	:	US
Telephone Number	:	410-455-9893
Fax Number	:	410-455-5380

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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