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General NPI Number Information
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NPI Number | 1104238658
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Entity Type | Organization
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Legal Business Name | FELTZER 2020 DENTAL MANAGEMENT LLC
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Dates
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Enumeration Date | 06/02/2014
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 965 HEATHROW LN
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City | AVON
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State | IN
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Zip | 46123-6787
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Country | US
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Telephone | 317-727-1534
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Fax |
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Provider Business Mailing Address
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Address Line | 965 HEATHROW LN
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City | AVON
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State | IN
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Zip | 46123-6787
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Country | US
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Telephone | 317-727-1534
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | DR. RONALD PROKES
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Credential | DDS
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Telephone | 317-727-1534
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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 |
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License Number State |
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