Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 5852983 | UT |
N | 1223X0400X | Orthodontists | 8972 | CO |
NPI | 1053471896 |
---|---|
Provider Name | Dr. Joseph Feller |
First Address | Bountiful, UT 84010-3882 |
Second Address | Bountiful, UT 84010-3882 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/07/2007 |