Provider Demographics
NPI:1477866648
Name:FELICIA DO DMD INC
Entity Type:Organization
Organization Name:FELICIA DO DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:661-845-4400
Mailing Address - Street 1:8001 ALICANTE AVE
Mailing Address - Street 2:
Mailing Address - City:LAMONT
Mailing Address - State:CA
Mailing Address - Zip Code:93241-1712
Mailing Address - Country:US
Mailing Address - Phone:661-845-4400
Mailing Address - Fax:661-845-4700
Practice Address - Street 1:501 W KERN AVE
Practice Address - Street 2:
Practice Address - City:MC FARLAND
Practice Address - State:CA
Practice Address - Zip Code:93250-1354
Practice Address - Country:US
Practice Address - Phone:661-792-3028
Practice Address - Fax:661-792-3564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47878261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental