Provider Demographics
NPI:1962407734
Name:FEDER, BARRY A (DDS, PS)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:A
Last Name:FEDER
Suffix:
Gender:M
Credentials:DDS, PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 NW GILMAN BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2483
Mailing Address - Country:US
Mailing Address - Phone:425-392-7541
Mailing Address - Fax:425-391-3869
Practice Address - Street 1:450 NW GILMAN BLVD
Practice Address - Street 2:STE 103
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2483
Practice Address - Country:US
Practice Address - Phone:425-392-7541
Practice Address - Fax:425-391-3869
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA47181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA05036OtherWASHINGTON DENTAL SERVICE
WA5503602Medicaid