Provider Demographics
NPI:1336162585
Name:FELTON, JOHN C (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:FELTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JACK
Other - Middle Name:C
Other - Last Name:FELTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:40 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-2241
Mailing Address - Country:US
Mailing Address - Phone:419-447-3050
Mailing Address - Fax:419-447-3088
Practice Address - Street 1:40 CLAY ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2241
Practice Address - Country:US
Practice Address - Phone:419-447-3050
Practice Address - Fax:419-447-3088
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH180141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice