Provider Demographics
NPI:1124637137
Name:FEASTER, ERIC ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ALAN
Last Name:FEASTER
Suffix:
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 1:4701 N GALLOWAY AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-7533
Mailing Address - Country:US
Mailing Address - Phone:214-269-5458
Mailing Address - Fax:
Practice Address - Street 1:4701 N GALLOWAY AVE STE 110
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-7533
Practice Address - Country:US
Practice Address - Phone:214-269-5458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-26
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36339122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist