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General NPI Number Information
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NPI Number | 1659555076
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Entity Type | Individual
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Provider Name | DAVID MAX FELLARS DDS
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Gender | Male
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Dates
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Enumeration Date | 12/20/2007
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Last Update Date | 06/07/2022
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Provider Practice Location Address
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Address Line | 3607 ALOMA AVE STE 1031
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City | OVIEDO
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State | FL
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Zip | 32765-8856
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Country | US
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Telephone | 321-304-6777
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Fax |
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Provider Business Mailing Address
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Address Line | 6244 WOODHAVEN VILLAGE DR
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City | PORT ORANGE
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State | FL
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Zip | 32128-6850
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Country | US
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Telephone | 760-889-8226
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN26885
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 51777
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License Number State | CA
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