Provider Demographics
NPI:1740610864
Name:VIQUEZ, JOSE DAVID (DDS)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:DAVID
Last Name:VIQUEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1100 FLORIDA AVE
Mailing Address - Street 2:ROOM #3341
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119
Mailing Address - Country:US
Mailing Address - Phone:504-941-8184
Mailing Address - Fax:504-941-8170
Practice Address - Street 1:1100 FLORIDA AVE
Practice Address - Street 2:LSU SCHOOL OF DENTISTRY
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119
Practice Address - Country:US
Practice Address - Phone:504-941-8282
Practice Address - Fax:504-941-8170
Is Sole Proprietor?:No
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA56701223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics