MEDICARE: STANLEY FELLMAN & JEANNE STRATHEARN, D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3385	CT

General Provider Information

NPI Number	:	1023205176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STANLEY FELLMAN & JEANNE STRATHEARN, D.D.S.

Provider Business Mailing Address
First Line	:	12 N MAIN ST
Second Line	:	SUITE 101
City	:	WEST HARTFORD
State	:	CT
Zip	:	06107-1932
Country	:	US
Telephone Number	:	860-236-4249
Fax Number	:	860-236-3726

Provider Business Practice Location Address
First Line	:	12 N MAIN ST
Second Line	:	SUITE 101
City	:	WEST HARTFORD
State	:	CT
Zip	:	06107-1932
Country	:	US
Telephone Number	:	860-236-4249
Fax Number	:	860-236-3726

Authorized Official
Title or Position	:	DENTIST
Name	:	STANLEY FELLMAN
Credential	:	D.D.S
Telephone Number	:	860-236-4249

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	10/02/2007

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