Provider Demographics
NPI:1699879312
Name:FEI, TIAN (DDS)
Entity type:Individual
Prefix:
First Name:TIAN
Middle Name:
Last Name:FEI
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:PO BOX 844
Mailing Address - Street 2:
Mailing Address - City:PARKSLEY
Mailing Address - State:VA
Mailing Address - Zip Code:23421
Mailing Address - Country:US
Mailing Address - Phone:757-665-7729
Mailing Address - Fax:757-665-7729
Practice Address - Street 1:24277 COOKE ST
Practice Address - Street 2:
Practice Address - City:PARKSLEY
Practice Address - State:VA
Practice Address - Zip Code:23421
Practice Address - Country:US
Practice Address - Phone:757-665-7729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014100821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
018295OtherANTHEM
VA010021928Medicaid
10082OtherDELTA DENTAL
133031OtherUNITED CONCORDIA