MEDICARE: DR. PAUL FELDER D.M.D.

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	240888	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902802655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL FELDER D.M.D.

Provider Business Mailing Address
First Line	:	2683 HIGHWAY 15
Second Line	:
City	:	BAY SPRINGS
State	:	MS
Zip	:	39422-7431
Country	:	US
Telephone Number	:	601-764-2745
Fax Number	:	601-764-3487

Provider Business Practice Location Address
First Line	:	2683 HIGHWAY 15
Second Line	:
City	:	BAY SPRINGS
State	:	MS
Zip	:	39422-7431
Country	:	US
Telephone Number	:	601-764-2745
Fax Number	:	601-764-3487

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	10/20/2009

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Directions to “ DR. PAUL FELDER D.M.D.” Practice Location

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