=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174602650
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IRWIN S. FELDMAN,D.D.S.,LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 313 PARK AVE SUITE G1
-----------------------------------------------------
City | FALLS CHURCH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22046-3327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-534-3730
-----------------------------------------------------
Fax | 703-534-3751
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 313 PARK AVE SUITE G1
-----------------------------------------------------
City | FALLS CHURCH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22046-3327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-534-3730
-----------------------------------------------------
Fax | 703-534-3751
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | IRWIN STUART FELDMAN
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 703-534-3730
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------