Provider Demographics
NPI:1508587619
Name:FELICIANO, JORALDINE ALAS II (DDS)
Entity Type:Individual
Prefix:DR
First Name:JORALDINE
Middle Name:ALAS
Last Name:FELICIANO
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JORALD
Other - Middle Name:ALAS
Other - Last Name:FELICIANO
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:11246 VOLLMER DR
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-4874
Mailing Address - Country:US
Mailing Address - Phone:909-557-8811
Mailing Address - Fax:
Practice Address - Street 1:164 W HOSPITALITY LN STE 127
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3316
Practice Address - Country:US
Practice Address - Phone:909-453-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1079801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice