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NPI Code Detail

MEDICARE: DR. JEFFREY T FESTER D.M.D.

MEDICARE:  DR. JEFFREY T FESTER  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
11223G0001XGeneral Practice Dentistry10586GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1546011OTHERGAUNITED CONCORDIA

General Provider Information

NPI Number : 1487741401
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY T FESTER D.M.D.
Provider Business Mailing Address
First Line : 1455 OLD ALABAMA RD
Second Line : SUITE 120
City : ROSWELL
State : GA
Zip : 30076-2129
Country : US
Telephone Number : 770-587-4202
Fax Number : 770-587-2412
Provider Business Practice Location Address
First Line : 1455 OLD ALABAMA RD
Second Line : SUITE 120
City : ROSWELL
State : GA
Zip : 30076-2129
Country : US
Telephone Number : 770-587-4202
Fax Number : 770-587-2412
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2006
Last Update Date : 07/08/2007

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Directions to “ DR. JEFFREY T FESTER D.M.D.” Practice Location

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