Healthcare Provider Details

I. General information

NPI: 1588292908
Provider Name (Legal Business Name): JOSE HINOJOSA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 QUARRY ST STE 100
FALL RIVER MA
02723-1026
US

IV. Provider business mailing address

169 AQUIDNECK ST APT 2
NEW BEDFORD MA
02744-2005
US

V. Phone/Fax

Practice location:
  • Phone: 347-748-4100
  • Fax:
Mailing address:
  • Phone: 347-748-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number186478459
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: