Provider Demographics
NPI:1235198953
Name:OQUENDO, JOSE L (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:L
Last Name:OQUENDO
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:PO BOX 1213
Mailing Address - Street 2:
Mailing Address - City:NAGUABO
Mailing Address - State:PR
Mailing Address - Zip Code:00718-1213
Mailing Address - Country:US
Mailing Address - Phone:787-874-2004
Mailing Address - Fax:787-874-2004
Practice Address - Street 1:30 CALLE GOYCO
Practice Address - Street 2:
Practice Address - City:NAGUABO
Practice Address - State:PR
Practice Address - Zip Code:00718-2255
Practice Address - Country:US
Practice Address - Phone:787-874-2004
Practice Address - Fax:787-874-2004
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice