Provider Demographics
NPI:1962810820
Name:FELDMAN, GREGORY (DMD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2723 NE 25TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-3986
Mailing Address - Country:US
Mailing Address - Phone:727-776-5965
Mailing Address - Fax:
Practice Address - Street 1:9277 SE MARICAMP RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-2341
Practice Address - Country:US
Practice Address - Phone:352-687-2354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20823122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist