Provider Demographics
NPI:1962620120
Name:JOSE A. ITURREGUI, D.D.S., M.S., P.A.
Entity type:Organization
Organization Name:JOSE A. ITURREGUI, D.D.S., M.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ITURREGUI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:386-775-7000
Mailing Address - Street 1:177 E GRAVES AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-5263
Mailing Address - Country:US
Mailing Address - Phone:386-775-7000
Mailing Address - Fax:386-775-7019
Practice Address - Street 1:177 E GRAVES AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-5263
Practice Address - Country:US
Practice Address - Phone:386-775-7000
Practice Address - Fax:386-775-7019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0014097122300000X, 1223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty