Provider Demographics
NPI:1184791709
Name:FELICIANO, ROSE (DMD)
Entity type:Individual
Prefix:DR
First Name:ROSE
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 1:2577 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-1003
Mailing Address - Country:US
Mailing Address - Phone:408-433-5555
Mailing Address - Fax:408-433-0848
Practice Address - Street 1:2577 N 1ST ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-1003
Practice Address - Country:US
Practice Address - Phone:408-433-5555
Practice Address - Fax:408-433-0848
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA389931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice