=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629253695
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | URREA-FELDSBERG DDS,MDS,PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2008
-----------------------------------------------------
Last Update Date | 01/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5440 SHADY OAK LANE
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33312-6224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-966-7762
-----------------------------------------------------
Fax | 954-966-7762
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5440 SHADY OAK LANE
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33312-6224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-966-7762
-----------------------------------------------------
Fax | 954-966-7762
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. HELENA URREA-FELDSBERG
-----------------------------------------------------
Credential | DDS,MDS
-----------------------------------------------------
Telephone | 954-966-7762
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | DN16226
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------