Provider Demographics
NPI:1386946465
Name:FELICIANO, YANITZA (DMD)
Entity type:Individual
Prefix:DR
First Name:YANITZA
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 1:4444 WESTHEIMER RD
Mailing Address - Street 2:APT 117
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-4800
Mailing Address - Country:US
Mailing Address - Phone:787-560-0633
Mailing Address - Fax:
Practice Address - Street 1:1800 MCRAE BLVD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-6706
Practice Address - Country:US
Practice Address - Phone:915-592-4168
Practice Address - Fax:915-591-5014
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26117122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist