Provider Demographics
NPI:1598019028
Name:ARGUETA, ENRIQUE ADOLFO (DDS)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:ADOLFO
Last Name:ARGUETA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13215 VAN NUYS BLVD.
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-2562
Mailing Address - Country:US
Mailing Address - Phone:818-890-6442
Mailing Address - Fax:818-890-2553
Practice Address - Street 1:13215 VAN NUYS BLVD.
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-2562
Practice Address - Country:US
Practice Address - Phone:818-890-6442
Practice Address - Fax:818-890-2553
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61906122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist