Healthcare Provider Details

I. General information

NPI: 1659547701
Provider Name (Legal Business Name): FELICIANO A ESPAILLAT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 JUNCTION BLVD
CORONA NY
11368-1742
US

IV. Provider business mailing address

109 E 167TH ST
BRONX NY
10452-8204
US

V. Phone/Fax

Practice location:
  • Phone: 718-544-8000
  • Fax: 718-466-0782
Mailing address:
  • Phone: 718-294-3725
  • Fax: 718-466-0782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number048323
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: