Provider Demographics
NPI:1659547701
Name:ESPAILLAT, FELICIANO A (DDS)
Entity Type:Individual
Prefix:
First Name:FELICIANO
Middle Name:A
Last Name:ESPAILLAT
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 1:109 E 167TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-8204
Mailing Address - Country:US
Mailing Address - Phone:718-294-3725
Mailing Address - Fax:718-466-0782
Practice Address - Street 1:3545 JUNCTION BLVD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-1742
Practice Address - Country:US
Practice Address - Phone:718-544-8000
Practice Address - Fax:718-466-0782
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048323122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist