Healthcare Provider Details

I. General information

NPI: 1023250255
Provider Name (Legal Business Name): DENTALAND, FT PIERCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 S FEDERAL HWY SABAL PALM PLAZA
FORT PIERCE FL
34982-5922
US

IV. Provider business mailing address

3230 W COMMERCIAL BLVD SUITE 190
FORT LAUDERDALE FL
33309-3429
US

V. Phone/Fax

Practice location:
  • Phone: 772-464-4646
  • Fax: 772-460-9967
Mailing address:
  • Phone: 954-719-4420
  • Fax: 954-678-9539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN5487
License Number StateFL

VIII. Authorized Official

Name: DR. JEFFREY FEINGOLD
Title or Position: CEO
Credential: DDS
Phone: 954-719-4420