Provider Demographics
NPI:1881769800
Name:JAUREGUI, JOSE H (DDS)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:H
Last Name:JAUREGUI
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 1:1182 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638
Mailing Address - Country:US
Mailing Address - Phone:559-675-7000
Mailing Address - Fax:559-675-9596
Practice Address - Street 1:1182 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638
Practice Address - Country:US
Practice Address - Phone:559-675-7000
Practice Address - Fax:559-675-9596
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD41425122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9147901OtherMEDICAL
CAB4142501OtherDELTA DENTAL HEALTH FAMIL
CA9179724OtherDORAL