MEDICARE: DR. EDMUND H FEY 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	122300000X	Dentist	26631	CA

General Provider Information

NPI Number	:	1871742932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDMUND H FEY D.D.S.

Provider Business Mailing Address
First Line	:	56928 BUCKHORN CT
Second Line	:
City	:	NORTH FORK
State	:	CA
Zip	:	93643-9572
Country	:	US
Telephone Number	:	559-877-2414
Fax Number	:

Provider Business Practice Location Address
First Line	:	56928 BUCKHORN CT
Second Line	:
City	:	NORTH FORK
State	:	CA
Zip	:	93643-9572
Country	:	US
Telephone Number	:	559-877-2414
Fax Number	:

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

Provider Enumeration Date	:	09/14/2008
Last Update Date	:	09/14/2008

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