Individual
JOSE R DE JESUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
991 W HUDSON BLVD, GASTONIA, NC 28052-6430
(704) 853-5191
Mailing address
200 E 2ND AVE, GASTONIA, NC 28052-4358
(704) 874-1904
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
1817
PR
1223G0001X
General Practice Dentistry
Primary
12041
NC
Other
Enumeration date
09/21/2005
Last updated
10/22/2021
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