Healthcare Provider Details

I. General information

NPI: 1003809120
Provider Name (Legal Business Name): LOURDES FELICIANO-NIEVES DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LA TORRE DE PLAZA LAS AMERICAS SUITE 706, AVE ROOSEVELT 525
SAN JUAN PR
00918
US

IV. Provider business mailing address

PO BOX 194817
SAN JUAN PR
00919-4817
US

V. Phone/Fax

Practice location:
  • Phone: 787-277-0070
  • Fax:
Mailing address:
  • Phone: 787-277-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number1345
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: