Provider Demographics
NPI:1922465301
Name:PETER R. FELICIANO, D.M.D., INC
Entity Type:Organization
Organization Name:PETER R. FELICIANO, D.M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:FELICIANO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:951-485-2860
Mailing Address - Street 1:13373 PERRIS BLVD STE D306
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-4208
Mailing Address - Country:US
Mailing Address - Phone:951-485-2860
Mailing Address - Fax:951-485-2862
Practice Address - Street 1:13373 PERRIS BLVD STE D306
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-4208
Practice Address - Country:US
Practice Address - Phone:951-485-2860
Practice Address - Fax:951-485-2862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty