Provider Demographics
NPI:1902054588
Name:MARVIN R. FELDMAN, DMD, PA
Entity Type:Organization
Organization Name:MARVIN R. FELDMAN, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,PA
Authorized Official - Phone:561-748-4488
Mailing Address - Street 1:224 S OLD DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7487
Mailing Address - Country:US
Mailing Address - Phone:561-748-4488
Mailing Address - Fax:561-748-7849
Practice Address - Street 1:224 S OLD DIXIE HWY
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7487
Practice Address - Country:US
Practice Address - Phone:561-748-4488
Practice Address - Fax:561-748-7849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14849261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental