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NPI Code Detail

MEDICARE: THOMAS J FEDER DDS PC

MEDICARE: THOMAS J FEDER DDS PC
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
1261QD0000XDental Clinic/CenterIL

General Provider Information

NPI Number : 1578734489
Entity Type Code : Organization
Provider Name (Legal Business Name) : THOMAS J FEDER DDS PC
Provider Business Mailing Address
First Line : 16 N JACKSON ST
Second Line :
City : BELLEVILLE
State : IL
Zip : 62220-1425
Country : US
Telephone Number : 618-235-5141
Fax Number :
Provider Business Practice Location Address
First Line : 16 N JACKSON ST
Second Line :
City : BELLEVILLE
State : IL
Zip : 62220-1425
Country : US
Telephone Number : 618-235-5141
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. THOMAS JOSEPH FEDER
Credential : DDS
Telephone Number : 618-235-5141
Provider Enumeration Date : 03/19/2008
Last Update Date : 03/19/2008

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Directions to “THOMAS J FEDER DDS PC ” Practice Location

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