Provider Demographics
NPI:1023272143
Name:DE LA FUENTE, JULIO CESAR JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JULIO
Middle Name:CESAR
Last Name:DE LA FUENTE
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 1:5405 S MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-9183
Mailing Address - Country:US
Mailing Address - Phone:956-668-1780
Mailing Address - Fax:956-668-1781
Practice Address - Street 1:5405 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9183
Practice Address - Country:US
Practice Address - Phone:956-668-1780
Practice Address - Fax:956-668-1781
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX197881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice