=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780088625
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADRIENNE U. FEYOCK DDS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2014
-----------------------------------------------------
Last Update Date | 10/21/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 EL CERRO BLVD SUITE D
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94526-1744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-837-7277
-----------------------------------------------------
Fax | 925-831-1876
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 EL CERRO BLVD SUITE D
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94526-1744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-837-7277
-----------------------------------------------------
Fax | 925-831-1876
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ PRESIDENT
-----------------------------------------------------
Name | DR. ADRIENNE U FEYOCK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 925-837-7277
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 52981
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------