Healthcare Provider Details

I. General information

NPI: 1740610864
Provider Name (Legal Business Name): JOSE DAVID VIQUEZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2013
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 FLORIDA AVE LSU SCHOOL OF DENTISTRY
NEW ORLEANS LA
70119
US

IV. Provider business mailing address

1100 FLORIDA AVE ROOM #3341
NEW ORLEANS LA
70119
US

V. Phone/Fax

Practice location:
  • Phone: 504-941-8282
  • Fax: 504-941-8170
Mailing address:
  • Phone: 504-941-8184
  • Fax: 504-941-8170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number5670
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: