MEDICARE: DR. DAVID GERALD FEENEY DDS

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	5389	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	92639	OTHER	NC	BLUECROSS BLUESHIELD

General Provider Information

NPI Number	:	1922152958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID GERALD FEENEY DDS

Provider Business Mailing Address
First Line	:	3090 SENNA DR
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28105-6726
Country	:	US
Telephone Number	:	704-847-1000
Fax Number	:	704-844-9709

Provider Business Practice Location Address
First Line	:	3090 SENNA DR
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28105-6726
Country	:	US
Telephone Number	:	704-847-1000
Fax Number	:	704-844-9709

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	02/18/2015

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