Provider Demographics
NPI:1316079197
Name:FEIST, JON WILLIAM (DDS)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:WILLIAM
Last Name:FEIST
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 1:831 CRITTER CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-8674
Mailing Address - Country:US
Mailing Address - Phone:608-788-3384
Mailing Address - Fax:608-783-6654
Practice Address - Street 1:609 DAKOTA ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-1010
Practice Address - Country:US
Practice Address - Phone:608-783-6681
Practice Address - Fax:608-783-6654
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3522122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist