Provider Demographics
NPI:1184114464
Name:DONOSO, JORGE (DDS)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:DONOSO
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 1:8880 ROYAL PALM BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5727
Mailing Address - Country:US
Mailing Address - Phone:954-341-1040
Mailing Address - Fax:
Practice Address - Street 1:8880 ROYAL PALM BLVD STE 106
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5727
Practice Address - Country:US
Practice Address - Phone:954-341-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-13
Last Update Date:2018-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL115801223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics