Provider Demographics
NPI:1902802655
Name:FELDER, PAUL (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:FELDER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2683 HIGHWAY 15
Mailing Address - Street 2:
Mailing Address - City:BAY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39422-7431
Mailing Address - Country:US
Mailing Address - Phone:601-764-2745
Mailing Address - Fax:601-764-3487
Practice Address - Street 1:2683 HIGHWAY 15
Practice Address - Street 2:
Practice Address - City:BAY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39422-7431
Practice Address - Country:US
Practice Address - Phone:601-764-2745
Practice Address - Fax:601-764-3487
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2408881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0660272Medicaid