Provider Demographics
NPI:1851413512
Name:AGUIRRE, JOSE EDUARDO (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:EDUARDO
Last Name:AGUIRRE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 BABCOCK RD STE 20
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4438
Mailing Address - Country:US
Mailing Address - Phone:210-465-9311
Mailing Address - Fax:210-465-9311
Practice Address - Street 1:2020 BABCOCK RD STE 20
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4438
Practice Address - Country:US
Practice Address - Phone:210-465-9311
Practice Address - Fax:210-465-9311
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD12-7821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX007985701Medicaid
TXB12782-01OtherCHIPS PROGRAM
TX007985701Medicaid