Provider Demographics
NPI:1174570469
Name:FELICIANO, PETER PAUL (DMD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:PAUL
Last Name:FELICIANO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13373 PERRIS BLVD. SUITE D-306
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-4208
Mailing Address - Country:US
Mailing Address - Phone:951-485-2860
Mailing Address - Fax:951-485-2862
Practice Address - Street 1:13373 PERRIS BLVD
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-4206
Practice Address - Country:US
Practice Address - Phone:951-485-2860
Practice Address - Fax:951-485-2862
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA371041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice