Healthcare Provider Details

I. General information

NPI: 1518820901
Provider Name (Legal Business Name): JORALDINE ALAS FELICIANO II, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12085 HEACOCK ST
MORENO VALLEY CA
92557-7102
US

IV. Provider business mailing address

12085 HEACOCK ST
MORENO VALLEY CA
92557-7102
US

V. Phone/Fax

Practice location:
  • Phone: 909-486-9179
  • Fax:
Mailing address:
  • Phone: 909-486-9179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JORALDINE ALAS FELICIANO II
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 909-557-8811