Provider Demographics
NPI:1679006514
Name:NORIEGA, JOSE CARLOS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:CARLOS
Last Name:NORIEGA
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:ESTOCOLMO 961
Mailing Address - Street 2:
Mailing Address - City:JUAREZ
Mailing Address - State:CHIHUAHUA
Mailing Address - Zip Code:32310
Mailing Address - Country:MX
Mailing Address - Phone:656-613-7002
Mailing Address - Fax:
Practice Address - Street 1:112 DE LEON DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4510
Practice Address - Country:US
Practice Address - Phone:915-227-0874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ2395699122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX$$$$$$$$$OtherTAX ID NUMBER