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General NPI Number Information
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NPI Number | 1093368219
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Entity Type | Individual
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Provider Name | JUSTIN L FENG DMD
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Gender | Male
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Dates
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Enumeration Date | 07/17/2019
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Last Update Date | 03/04/2021
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Provider Practice Location Address
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Address Line | 968 E DUNDEE RD
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City | PALATINE
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State | IL
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Zip | 60074-8329
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Country | US
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Telephone | 847-221-0060
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Fax |
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Provider Business Mailing Address
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Address Line | 41 RIVER OAKS CIR E
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-8804
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Country | US
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Telephone | 847-971-5199
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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 | 019.021466
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License Number State | IL
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