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General NPI Number Information
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NPI Number | 1689757247
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Entity Type | Organization
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Legal Business Name | JOHN T FELDER DMD PA
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 10/06/2011
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Provider Practice Location Address
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Address Line | 1316 DELAWARE AVE
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City | MCCOMB
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State | MS
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Zip | 39648
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Country | US
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Telephone | 601-684-1971
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Fax |
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Provider Business Mailing Address
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Address Line | 1316 DELAWARE AVE
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City | MCCOMB
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State | MS
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Zip | 39648
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Country | US
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Telephone | 601-684-1971
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | MR. JOHN T FELDER
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Credential |
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Telephone | 601-684-1971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 282294
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License Number State | MS
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