Provider Demographics
NPI:1780646976
Name:AGUILERA, ARMANDO JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARMANDO
Middle Name:
Last Name:AGUILERA
Suffix:JR
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:DENTAC BLDG 2441 21ST STREET
Mailing Address - Street 2:
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5369
Mailing Address - Country:US
Mailing Address - Phone:270-798-8614
Mailing Address - Fax:270-798-8633
Practice Address - Street 1:DENTAC BLDG 2441 21ST STREET
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5369
Practice Address - Country:US
Practice Address - Phone:270-798-8614
Practice Address - Fax:270-798-8633
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0126561223G0001X
GADNO126561223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice