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General NPI Number Information
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NPI Number | 1457523714
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Entity Type | Organization
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Legal Business Name | ROBERT B FELSENFELD DDS PC
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 05/05/2010
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Provider Practice Location Address
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Address Line | 22731 NEWMAN ST SUITE 240
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City | DEARBORN
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State | MI
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Zip | 48124-3852
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Country | US
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Telephone | 313-562-1515
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Fax | 313-562-7439
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Provider Business Mailing Address
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Address Line | 22731 NEWMAN ST SUITE 240
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City | DEARBORN
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State | MI
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Zip | 48124-3852
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Country | US
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Telephone | 313-562-1515
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Fax | 313-562-7439
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT B FELSENFELD
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Credential | DDS
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Telephone | 313-562-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 2901013449
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License Number State | MI
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