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General NPI Number Information
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NPI Number | 1578802583
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Entity Type | Individual
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Provider Name | RICHARD ALAN FELT DDS
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Gender | Male
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Dates
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Enumeration Date | 02/11/2013
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Last Update Date | 02/11/2013
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Provider Practice Location Address
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Address Line | 1275 SHERMER RD SUITE 5
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City | NORTHBROOK
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State | IL
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Zip | 60062-4558
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Country | US
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Telephone | 847-480-1578
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Fax | 847-480-1579
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Provider Business Mailing Address
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Address Line | 2443 GREENWOOD RD
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City | GLENVIEW
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State | IL
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Zip | 60026-1156
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Country | US
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Telephone | 847-272-0930
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Fax | 847-272-0940
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 021-001049
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License Number State | IL
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