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General NPI Number Information
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NPI Number | 1073189254
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Entity Type | Individual
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Provider Name | DR. MICHELLE FENG
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Gender | Female
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Dates
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Enumeration Date | 05/28/2021
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Last Update Date | 05/28/2021
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Provider Practice Location Address
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Address Line | 1429 CHESTER BLVD STE A
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City | RICHMOND
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State | IN
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Zip | 47374-1919
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Country | US
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Telephone | 765-221-8446
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Fax |
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Provider Business Mailing Address
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Address Line | 2017 CENTRAL AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-1634
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Country | US
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Telephone | 574-453-8669
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12013623A
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License Number State | IN
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