Provider Demographics
NPI:1750786786
Name:CARMEN A FEOLI DDS PA
Entity type:Organization
Organization Name:CARMEN A FEOLI DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FEOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-949-5252
Mailing Address - Street 1:1490 NE MIAMI GDN DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4829
Mailing Address - Country:US
Mailing Address - Phone:305-949-5252
Mailing Address - Fax:305-949-5011
Practice Address - Street 1:1490 NE MIAMI GDN DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-4829
Practice Address - Country:US
Practice Address - Phone:305-949-5252
Practice Address - Fax:305-949-5011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18037122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty