=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770767345
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. JOSE I. ARAUZ-DUTARI,DMD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2007
-----------------------------------------------------
Last Update Date | 12/19/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 DOCTORS DR SUITE N
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28546-6308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-577-1315
-----------------------------------------------------
Fax | 910-577-1078
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 DOCTORS DR SUITE N
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28546-6308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-577-1315
-----------------------------------------------------
Fax | 910-577-1078
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JOSE I ARAUZ-DUTARI
-----------------------------------------------------
Credential | DMD, PA
-----------------------------------------------------
Telephone | 910-577-1315
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number | 8508
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------