Healthcare Provider Details

I. General information

NPI: 1205179330
Provider Name (Legal Business Name): SCOTT ERIC FEIGENBAUM DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2648 NW FEDERAL HWY
STUART FL
34994-9318
US

IV. Provider business mailing address

2 CHELSEA CT
HILTON HEAD ISLAND SC
29928-6113
US

V. Phone/Fax

Practice location:
  • Phone: 772-324-3414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number24152
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: