Provider Demographics
NPI:1518380294
Name:JOSE MANUEL TERRAZA DDS INC
Entity Type:Organization
Organization Name:JOSE MANUEL TERRAZA DDS INC
Other - Org Name:PACIFICA DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRAZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-483-3285
Mailing Address - Street 1:1804 SAVIERS RD STE B
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93033-3649
Mailing Address - Country:US
Mailing Address - Phone:805-483-3285
Mailing Address - Fax:
Practice Address - Street 1:1804 SAVIERS RD STE B
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-3649
Practice Address - Country:US
Practice Address - Phone:805-483-3285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty