Healthcare Provider Details

I. General information

NPI: 1073453072
Provider Name (Legal Business Name): DR. JORGE DANIEL AGUIRRE MACUAGA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 CAMBRIDGE ST # 5130
HOUSTON TX
77054-2032
US

IV. Provider business mailing address

7892 KNIGHT RD APT 5005
HOUSTON TX
77054-3098
US

V. Phone/Fax

Practice location:
  • Phone: 713-486-4000
  • Fax:
Mailing address:
  • Phone: 713-486-4219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number42383
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number42383
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number42383
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: