Provider Demographics
NPI:1245035914
Name:VERDUZCO, JOSUE DE JESUS (RDH)
Entity type:Individual
Prefix:
First Name:JOSUE
Middle Name:DE JESUS
Last Name:VERDUZCO
Suffix:
Gender:
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 HOSTETLER WAY W UNIT 2
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-5403
Mailing Address - Country:US
Mailing Address - Phone:541-993-5926
Mailing Address - Fax:
Practice Address - Street 1:813 HOSTETLER WAY W UNIT 2
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-5403
Practice Address - Country:US
Practice Address - Phone:541-993-5926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26624124Q00000X
ORH7537124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist