Provider Demographics
NPI:1962543652
Name:FELICIANO-GONZALEZ, NILMA Z (DMD)
Entity type:Individual
Prefix:
First Name:NILMA
Middle Name:Z
Last Name:FELICIANO-GONZALEZ
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:AA10 AVE SANTA JUANITA
Mailing Address - Street 2:URBANIZACION SANTA JUANITA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-4644
Mailing Address - Country:US
Mailing Address - Phone:787-787-5595
Mailing Address - Fax:787-779-0663
Practice Address - Street 1:AA10 AVE SANTA JUANITA
Practice Address - Street 2:URBANIZACION SANTA JUANITA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4644
Practice Address - Country:US
Practice Address - Phone:787-787-5595
Practice Address - Fax:787-779-0663
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7531223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8727OtherSOCIAL SECURITY