Individual
MR. JOSE DANIEL DE JESUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
74403
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
74403
DENTAL BOARD
CA
Enumeration date
01/14/2010
Last updated
01/14/2010
Update your record
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