Provider Demographics
NPI:1649469594
Name:FELICETTI, JEFFREY D (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:FELICETTI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1035 PARK BLVD
Mailing Address - Street 2:SUITE 2-D
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-2743
Mailing Address - Country:US
Mailing Address - Phone:516-795-7878
Mailing Address - Fax:516-795-0152
Practice Address - Street 1:1035 PARK BLVD
Practice Address - Street 2:SUITE 2-D
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-2743
Practice Address - Country:US
Practice Address - Phone:516-795-7878
Practice Address - Fax:516-795-0152
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0464931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics