NPIMap

Organization Active NPI

Jeffrey S. Feltzer, DMD, P.C.

  • General Practice Dentistry
  • Mishawaka, IN
National Provider Identifier
1194052183
Registry record updated Nov 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12010107A Issued in IN
Legal business name
JEFFREY S. FELTZER, DMD, P.C.
Practice address
518 Lincolnway W
Mishawaka, IN 46544-1807
Phone
(574) 255-5630
NPI assigned
Nov 11, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jeffrey S. Feltzer, DMD
Title
President
Phone
(574) 309-4791

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 12010107A IN Primary

Addresses

Primary practice location

518 Lincolnway W
Mishawaka, IN 46544-1807

Mailing address

PO Box 806
Middlebury, IN 46540-0806

Other identifiers 1

IdentifierTypeStateIssuer
200432580MedicaidIN

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1257897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257897600000",
    "number": "1194052183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 806",
            "city": "MIDDLEBURY",
            "state": "IN",
            "postal_code": "465400806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "518 LINCOLNWAY W",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465441807",
            "telephone_number": "574-255-5630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY S. FELTZER, DMD, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-11",
        "last_updated": "2009-11-11",
        "status": "A",
        "authorized_official_last_name": "FELTZER",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "574-309-4791",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12010107A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200432580",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mishawaka, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.