Provider Demographics
NPI:1124577374
Name:BERLANGA, JOSE EDDIE JR
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:EDDIE
Last Name:BERLANGA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N PUGET SOUND AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-5425
Mailing Address - Country:US
Mailing Address - Phone:253-535-4011
Mailing Address - Fax:253-507-7346
Practice Address - Street 1:601 N PUGET SOUND AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-5425
Practice Address - Country:US
Practice Address - Phone:253-535-4011
Practice Address - Fax:253-507-7346
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN00000135122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist