MEDICARE: KENNETH FEILER DMD

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	1223G0001X	General Practice Dentistry	DI01210600	NJ

General Provider Information

NPI Number	:	1568683019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH FEILER DMD

Provider Business Mailing Address
First Line	:	805 AMARYLLIS AVE
Second Line	:
City	:	ORADELL
State	:	NJ
Zip	:	07649-1405
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1060 MAIN ST
Second Line	:	SUITE 100
City	:	RIVER EDGE
State	:	NJ
Zip	:	07661-2591
Country	:	US
Telephone Number	:	201-342-3600
Fax Number	:	201-996-1021

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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