Provider Demographics
NPI:1154476117
Name:PULIDO, JOSE R (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:PULIDO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:R
Other - Last Name:PULIDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:310 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4207
Mailing Address - Country:US
Mailing Address - Phone:760-745-4451
Mailing Address - Fax:760-735-2425
Practice Address - Street 1:310 S BROADWAY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4207
Practice Address - Country:US
Practice Address - Phone:760-745-4451
Practice Address - Fax:760-735-2425
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice