Provider Demographics
NPI:1437769452
Name:LUCIANO MARMOLEJOS, FELIX ALBERTO (DDS)
Entity Type:Individual
Prefix:DR
First Name:FELIX
Middle Name:ALBERTO
Last Name:LUCIANO MARMOLEJOS
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 1:208 75TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-5709
Mailing Address - Country:US
Mailing Address - Phone:201-878-2112
Mailing Address - Fax:
Practice Address - Street 1:163 NEWINGTON RD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-2359
Practice Address - Country:US
Practice Address - Phone:860-231-1331
Practice Address - Fax:860-231-0363
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT128521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice