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General NPI Number Information
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NPI Number | 1609968940
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Entity Type | Organization
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Legal Business Name | RODNEY L FEASTER DDS PC
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | G4007 W COURT ST SUITE A
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City | FLINT
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State | MI
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Zip | 48532-3560
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Country | US
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Telephone | 810-235-5422
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Fax | 810-232-7473
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Provider Business Mailing Address
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Address Line | G4007 W COURT ST SUITE A
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City | FLINT
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State | MI
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Zip | 48532-3560
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Country | US
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Telephone | 810-235-5422
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Fax | 810-232-7473
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Authorized Official
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Title or Position | PRESIDENT
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Name | RODNEY LEE FEASTER
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Credential | DDS
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Telephone | 810-235-5422
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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 | 14072
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License Number State | MI
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Legacy Identifiers
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Identifier #1
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Identifier Code | 1658670
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Identifier Type | MEDICAID
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Identifier State | MI
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Identifier Issuer |
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 1658670
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Identifier Type | MEDICAID
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Identifier State | MI
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Identifier Issuer |
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