Provider Demographics
NPI:1306049093
Name:JUAREZ, JOSE VICENTE (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:VICENTE
Last Name:JUAREZ
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 1:2340 SUNRISE BLVD STE 25
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4369
Mailing Address - Country:US
Mailing Address - Phone:916-852-8510
Mailing Address - Fax:
Practice Address - Street 1:2340 SUNRISE BLVD STE 25
Practice Address - Street 2:
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4369
Practice Address - Country:US
Practice Address - Phone:916-852-8510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53804122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist