Provider Demographics
NPI:1154770121
Name:FELDHAUS, AUDRA ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:AUDRA
Middle Name:ANN
Last Name:FELDHAUS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E 69 HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:CLAYCOMO
Mailing Address - State:MO
Mailing Address - Zip Code:64119-3118
Mailing Address - Country:US
Mailing Address - Phone:816-454-0377
Mailing Address - Fax:
Practice Address - Street 1:415 E US HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64119-3118
Practice Address - Country:US
Practice Address - Phone:816-454-0377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016016433122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist