Provider Demographics
NPI:1801335237
Name:ROCHA PALAFOX, JORGE ALBERTO (DDS)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:ALBERTO
Last Name:ROCHA PALAFOX
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 1:2188 N BUCKINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-1460
Mailing Address - Country:US
Mailing Address - Phone:909-552-1457
Mailing Address - Fax:
Practice Address - Street 1:802 S MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-4809
Practice Address - Country:US
Practice Address - Phone:909-933-3524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101189122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist