Healthcare Provider Details

I. General information

NPI: 1790100980
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL FELDMAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2014
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 ANDRE ST SUITE 205
NEW IBERIA LA
70563-2159
US

IV. Provider business mailing address

1100 ANDRE ST SUITE 205
NEW IBERIA LA
70563-2159
US

V. Phone/Fax

Practice location:
  • Phone: 337-256-8999
  • Fax:
Mailing address:
  • Phone: 337-256-8999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6102
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: