Provider Demographics
NPI:1245243765
Name:FOSSAS FELIU, JOSE A (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:FOSSAS FELIU
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:A43 CALLE 1
Mailing Address - Street 2:PARQUES DE SAN IGNACIO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-4839
Mailing Address - Country:US
Mailing Address - Phone:787-785-1265
Mailing Address - Fax:
Practice Address - Street 1:24 CALLE DEGETAU
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6315
Practice Address - Country:US
Practice Address - Phone:787-785-1265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice