Provider Demographics
NPI:1770935413
Name:ALDANA, JOSE JUAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:JUAN
Last Name:ALDANA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:JUAN
Other - Last Name:ALDANA-BARBOSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3220 GUS THOMASSON RD
Mailing Address - Street 2:SUITE #347
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4057
Mailing Address - Country:US
Mailing Address - Phone:972-698-6685
Mailing Address - Fax:
Practice Address - Street 1:3220 GUS THOMASSON RD
Practice Address - Street 2:SUITE #347
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4057
Practice Address - Country:US
Practice Address - Phone:972-698-6685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31932122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist