Provider Demographics
NPI:1104238658
Name:FELTZER 2020 DENTAL MANAGEMENT LLC
Entity type:Organization
Organization Name:FELTZER 2020 DENTAL MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:PROKES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-727-1534
Mailing Address - Street 1:965 HEATHROW LN
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-6787
Mailing Address - Country:US
Mailing Address - Phone:317-727-1534
Mailing Address - Fax:
Practice Address - Street 1:965 HEATHROW LN
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6787
Practice Address - Country:US
Practice Address - Phone:317-727-1534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:20-20 DENTAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty