Provider Demographics
NPI:1861417305
Name:FERREIRA, JORGE R (DMD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:R
Last Name:FERREIRA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17805 HIGHWAY 84/285
Mailing Address - Street 2:
Mailing Address - City:POJOAQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87506
Mailing Address - Country:US
Mailing Address - Phone:505-455-2176
Mailing Address - Fax:505-455-2953
Practice Address - Street 1:17805 HIGHWAY 84/285
Practice Address - Street 2:
Practice Address - City:POJOAQUE
Practice Address - State:NM
Practice Address - Zip Code:87506
Practice Address - Country:US
Practice Address - Phone:505-455-2176
Practice Address - Fax:505-455-2953
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM22731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice