Provider Demographics
NPI:1417485806
Name:FELKNER, JUSTIN WYATT (DDS)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:WYATT
Last Name:FELKNER
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 1:1206 CENTRAL TEXAS EXPY
Mailing Address - Street 2:
Mailing Address - City:LAMPASAS
Mailing Address - State:TX
Mailing Address - Zip Code:76550-3321
Mailing Address - Country:US
Mailing Address - Phone:512-556-2090
Mailing Address - Fax:
Practice Address - Street 1:1206 CENTRAL TEXAS EXPY
Practice Address - Street 2:
Practice Address - City:LAMPASAS
Practice Address - State:TX
Practice Address - Zip Code:76550-3321
Practice Address - Country:US
Practice Address - Phone:512-556-2090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-30
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33112122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist