Healthcare Provider Details

I. General information

NPI: 1942598982
Provider Name (Legal Business Name): AMY FELLER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 07/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 W WELLINGTON AVE
CHICAGO IL
60657-5123
US

IV. Provider business mailing address

811 W WELLINGTON AVE
CHICAGO IL
60657-5123
US

V. Phone/Fax

Practice location:
  • Phone: 773-871-1461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019028737
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: