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General NPI Number Information
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NPI Number | 1851579940
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Entity Type | Organization
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Legal Business Name | FEHLMAN DENTAL PRACTICE, LTD
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Dates
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Enumeration Date | 01/31/2008
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Last Update Date | 01/31/2008
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Provider Practice Location Address
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Address Line | 116 W 2ND ST
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City | GENESEO
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State | IL
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Zip | 61254-1320
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Country | US
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Telephone | 309-944-6401
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Fax | 309-945-4311
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Provider Business Mailing Address
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Address Line | PO BOX 109
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City | GENESEO
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State | IL
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Zip | 61254-0109
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Country | US
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Telephone | 309-944-6401
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Fax | 309-945-4311
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRUCE RICHARD FEHLMAN
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Credential | D.D.S.
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Telephone | 309-944-6401
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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 | IL
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