Provider Demographics
NPI:1245411040
Name:AGUILAR, JORGE MAURICIO (DDS)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:MAURICIO
Last Name:AGUILAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 FLEUR DE LIS DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-1246
Mailing Address - Country:US
Mailing Address - Phone:504-486-3339
Mailing Address - Fax:
Practice Address - Street 1:6000 FLEUR DE LIS DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-1246
Practice Address - Country:US
Practice Address - Phone:504-486-3339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4254122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist