Provider Demographics
NPI:1588620975
Name:AGUDA, JOSEPHINE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:A
Last Name:AGUDA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 S HARBOR BLVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-7534
Mailing Address - Country:US
Mailing Address - Phone:714-680-4521
Mailing Address - Fax:714-680-4823
Practice Address - Street 1:1480 S HARBOR BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-7534
Practice Address - Country:US
Practice Address - Phone:714-680-4521
Practice Address - Fax:714-680-4823
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2010-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA472221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice