Provider Demographics
NPI:1912926999
Name:BERLANGA, JOSE RAFAEL (DDS)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:RAFAEL
Last Name:BERLANGA
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 1:1378 CHITTIM TRL
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-3890
Mailing Address - Country:US
Mailing Address - Phone:830-773-3700
Mailing Address - Fax:830-758-1960
Practice Address - Street 1:2403 N VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-6483
Practice Address - Country:US
Practice Address - Phone:830-773-3700
Practice Address - Fax:830-758-1960
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX190981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice