MEDICARE: AJIKWAGA BATIDO FELLI DMD

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	25045	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25045	OTHER	TX	TEXAS LICENSE NUMBER

General Provider Information

NPI Number	:	1619208246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AJIKWAGA BATIDO FELLI DMD

Provider Business Mailing Address
First Line	:	432 N 6TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-4004
Country	:	US
Telephone Number	:	215-724-4700
Fax Number	:	215-724-0919

Provider Business Practice Location Address
First Line	:	432 N 6TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-4004
Country	:	US
Telephone Number	:	215-724-4700
Fax Number	:	215-724-0919

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2010
Last Update Date	:	12/06/2013

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