1235109349 NPI number — DR. ROBERT BRUCE FELSENFELD D.D.S.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235109349 NPI number — DR. ROBERT BRUCE FELSENFELD D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FELSENFELD
Provider First Name:
ROBERT
Provider Middle Name:
BRUCE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FELSENFELD
Provider Other First Name:
ROBERT
Provider Other Middle Name:
BRUCE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.D.S.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1235109349
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22731 NEWMAN ST
Provider Second Line Business Mailing Address:
SUITE 240
Provider Business Mailing Address City Name:
DEARBORN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48124-2034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-562-1515
Provider Business Mailing Address Fax Number:
313-562-7439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22731 NEWMAN ST
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48124-3852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-562-1515
Provider Business Practice Location Address Fax Number:
313-562-7439
Provider Enumeration Date:
01/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  RF013449 , 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)





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