Provider Demographics
NPI:1427085919
Name:FELICIANO, LIZA MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:LIZA
Middle Name:MARIE
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 1:17501 BISCAYNE BLVD.
Mailing Address - Street 2:SUITE 570
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160
Mailing Address - Country:US
Mailing Address - Phone:305-947-6447
Mailing Address - Fax:
Practice Address - Street 1:17501 BISCAYNE BLVD
Practice Address - Street 2:SUITE 570
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-4802
Practice Address - Country:US
Practice Address - Phone:305-947-6447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN163311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice