Provider Demographics
NPI:1437174976
Name:AGUIRRE, JOSE ANTONIO (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANTONIO
Last Name:AGUIRRE
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:K5 CALLE 1
Mailing Address - Street 2:VALPARAISO
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4004
Mailing Address - Country:US
Mailing Address - Phone:787-261-0708
Mailing Address - Fax:787-870-1508
Practice Address - Street 1:16 CALLE BARCELO
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-2444
Practice Address - Country:US
Practice Address - Phone:787-870-1529
Practice Address - Fax:787-870-1508
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR09821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR40919OtherTRIPLE-S
PRPREFERED CHOICEOtherPREFERED CHOICE
PR0982OtherSTATE DENTAL LICENSE
PR008809OtherPROFESIONAL REGISTER
PR040476OtherCRUZ AZUL
PR2061013OtherPREFERED HEALTH
PRHUMANAOtherHUMANA