Provider Demographics
NPI:1881642593
Name:PEDROZA, JOSE G (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:G
Last Name:PEDROZA
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 1:1218 LAKE POINT DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-7481
Mailing Address - Country:US
Mailing Address - Phone:904-434-3035
Mailing Address - Fax:
Practice Address - Street 1:1218 LAKE POINT DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-7481
Practice Address - Country:US
Practice Address - Phone:904-434-3035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19024714122300000X
CA515341223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0700XDental ProvidersDentistProsthodontics