Provider Demographics
NPI:1275688079
Name:FELICIANO, YELITZA (DMD)
Entity Type:Individual
Prefix:DR
First Name:YELITZA
Middle Name:
Last Name:FELICIANO
Suffix:
Gender:F
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:STREET UNION NUM.10
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-860-3366
Mailing Address - Fax:787-860-3366
Practice Address - Street 1:STREET 10 UNION
Practice Address - Street 2:SUITE 106
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-860-3366
Practice Address - Fax:787-860-3366
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR26781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice