Provider Demographics
NPI:1437671229
Name:JAUREGUI, ALLAN RODRIGO (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:RODRIGO
Last Name:JAUREGUI
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 1:19534 AZURE OAK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3114
Mailing Address - Country:US
Mailing Address - Phone:210-372-2029
Mailing Address - Fax:
Practice Address - Street 1:1507 E COURT ST STE 107
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5265
Practice Address - Country:US
Practice Address - Phone:830-372-9979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33217122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33217OtherTEXAS STATE BOARD OF DENTAL EXAMINERS