Provider Demographics
NPI:1811181951
Name:ROSE M. FELICIANO DMD INC
Entity type:Organization
Organization Name:ROSE M. FELICIANO DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FELICIANO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:408-433-5555
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:140-843-3555
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:140-843-3555
Practice Address - Fax:408-433-0848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38993261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4084335555OtherDENTICAL