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General NPI Number Information
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NPI Number | 1669036117
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Entity Type | Organization
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Legal Business Name | FELDKAMP CAL SELECT DENTAL GROUP, INC.
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Dates
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Enumeration Date | 04/30/2019
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Last Update Date | 08/18/2020
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Provider Practice Location Address
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Address Line | 164 W HOSPITALITY LN STE 127
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3316
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Country | US
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Telephone | 909-453-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 164 W. HOSPITALITY LANE SUITE 127
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3329
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Country | US
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Telephone | 909-723-1088
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. IRVING MOORE FELDKAMP III
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Credential | DDS
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Telephone | 909-453-6600
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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 |
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License Number State |
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