Provider Demographics
NPI:1386070878
Name:GRUPO DENTAL DR JOSE M FELIU BAE PSC
Entity type:Organization
Organization Name:GRUPO DENTAL DR JOSE M FELIU BAE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FELIU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-533-5573
Mailing Address - Street 1:531 AVE ANTONIO R BARCELO
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-4189
Mailing Address - Country:US
Mailing Address - Phone:787-533-5573
Mailing Address - Fax:
Practice Address - Street 1:531 AVE ANTONIO R BARCELO
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-4189
Practice Address - Country:US
Practice Address - Phone:787-533-5573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2241122300000X
PR945122300000X
PR21971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty