Provider Demographics
NPI:1295133742
Name:JOSE V. JUAREZ, D.D.S. INC.
Entity type:Organization
Organization Name:JOSE V. JUAREZ, D.D.S. INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:VICENTE
Authorized Official - Last Name:JUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-897-3260
Mailing Address - Street 1:2340 SUNRISE BLVD
Mailing Address - Street 2:SUITE 25
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4303
Mailing Address - Country:US
Mailing Address - Phone:916-897-3260
Mailing Address - Fax:
Practice Address - Street 1:2340 SUNRISE BLVD
Practice Address - Street 2:SUITE 25
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4303
Practice Address - Country:US
Practice Address - Phone:916-897-3260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53804122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty