Provider Demographics
NPI:1811000680
Name:FELICIANO, JACKELINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JACKELINE
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:AA # 8 DON PELAYO AVENUE
Mailing Address - Street 2:AA-8 HACIENDAS DEL NORTE
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-251-1177
Mailing Address - Fax:787-250-8156
Practice Address - Street 1:AA # 8 DON PELAYO AVE.
Practice Address - Street 2:URB. HACIENDAS DEL NORTE
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-251-1177
Practice Address - Fax:787-250-8156
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice