Provider Demographics
NPI:1144989195
Name:ADAM FELLINE, DMD PLLC
Entity type:Organization
Organization Name:ADAM FELLINE, DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FELLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:646-270-5152
Mailing Address - Street 1:801 MOTOR PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-5256
Mailing Address - Country:US
Mailing Address - Phone:631-348-1501
Mailing Address - Fax:
Practice Address - Street 1:801 MOTOR PKWY STE 104
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-5256
Practice Address - Country:US
Practice Address - Phone:631-974-5244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty