Provider Demographics
NPI:1730252651
Name:FEELEY, MATTHEW S (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:S
Last Name:FEELEY
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 1:1027 SOUTHERN ARTERY
Mailing Address - Street 2:APT 602
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169
Mailing Address - Country:US
Mailing Address - Phone:617-481-9938
Mailing Address - Fax:
Practice Address - Street 1:12 POST OFFICE SQUARE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:82109
Practice Address - Country:US
Practice Address - Phone:617-542-8808
Practice Address - Fax:617-451-1912
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice