1609968940 NPI number — RODNEY L FEASTER DDS PC

Table of content: (NPI 1609968940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609968940 NPI number — RODNEY L FEASTER DDS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RODNEY L FEASTER DDS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FAMILY DENTAL HEALTHCARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609968940
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
G4007 W COURT ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48532-3560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-235-5422
Provider Business Mailing Address Fax Number:
810-232-7473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
G4007 W COURT ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48532-3560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-235-5422
Provider Business Practice Location Address Fax Number:
810-232-7473
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FEASTER
Authorized Official First Name:
RODNEY
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
810-235-5422

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  14072 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1658670 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com