Provider Demographics
NPI:1104950864
Name:FELLRATH, JOHN F III (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:FELLRATH
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3757 WOODFORD PL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45430-1671
Mailing Address - Country:US
Mailing Address - Phone:937-431-9667
Mailing Address - Fax:
Practice Address - Street 1:2033 E STROOP RD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-4125
Practice Address - Country:US
Practice Address - Phone:937-293-6329
Practice Address - Fax:937-293-9961
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300194601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice