MEDICARE: WHETTEN FELLER ORTHODONTICS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	S4343	NV

General Provider Information

NPI Number	:	1285026005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHETTEN FELLER ORTHODONTICS

Provider Business Mailing Address
First Line	:	4540 S PECOS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5923
Country	:	US
Telephone Number	:	702-436-0999
Fax Number	:

Provider Business Practice Location Address
First Line	:	4540 S PECOS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5923
Country	:	US
Telephone Number	:	702-436-0999
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JEDEDIAH FELLER
Credential	:	DDS MSD
Telephone Number	:	702-436-0999

Provider Enumeration Date	:	03/03/2015
Last Update Date	:	03/03/2015

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