Provider Demographics
NPI:1518354067
Name:JOSE MALDONADO
Entity Type:Organization
Organization Name:JOSE MALDONADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:915-288-9821
Mailing Address - Street 1:GOMEZ MORIN BLVD. #7050
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JUAREZ
Mailing Address - State:CHIHUAHUA
Mailing Address - Zip Code:32500
Mailing Address - Country:MX
Mailing Address - Phone:915-288-9821
Mailing Address - Fax:
Practice Address - Street 1:GOMEZ MORIN BLVD. #7050
Practice Address - Street 2:SUITE 2
Practice Address - City:JUAREZ
Practice Address - State:CHIHUAHUA
Practice Address - Zip Code:32500
Practice Address - Country:MX
Practice Address - Phone:915-288-9821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ5822213122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty