MEDICARE: BARRY A FEDER DDS, PS

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	4718	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05036	OTHER	WA	WASHINGTON DENTAL SERVICE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962407734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARRY A FEDER DDS, PS

Provider Business Mailing Address
First Line	:	450 NW GILMAN BLVD
Second Line	:	STE 103
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-2483
Country	:	US
Telephone Number	:	425-392-7541
Fax Number	:	425-391-3869

Provider Business Practice Location Address
First Line	:	450 NW GILMAN BLVD
Second Line	:	STE 103
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-2483
Country	:	US
Telephone Number	:	425-392-7541
Fax Number	:	425-391-3869

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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