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General NPI Number Information
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NPI Number | 1427675412
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Entity Type | Organization
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Legal Business Name | FELDKAMP CAL SELECT DENTAL GROUP, INC.
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Dates
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Enumeration Date | 06/25/2020
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Last Update Date | 09/08/2020
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Provider Practice Location Address
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Address Line | 8325 HAVEN AVE STE 120
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3894
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Country | US
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Telephone | 909-332-6980
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10669
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City | SAN BERNARDINO
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State | CA
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Zip | 92423-0669
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. IRVING MOORE FELDKAMP III
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Credential | DDS
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Telephone | 909-332-6980
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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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