Provider Demographics
NPI:1013199819
Name:FEOLI, CARMEN ALICIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:ALICIA
Last Name:FEOLI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 NE MIAMI GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4829
Mailing Address - Country:US
Mailing Address - Phone:305-949-5252
Mailing Address - Fax:305-949-5011
Practice Address - Street 1:1490 NE MIAMI GARDENS DR
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179
Practice Address - Country:US
Practice Address - Phone:305-949-5252
Practice Address - Fax:305-949-5011
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 180371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice