Provider Demographics
NPI:1902460439
Name:GIRAUD, JOSE JOAQUIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:JOAQUIN
Last Name:GIRAUD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 N 7TH ST APT 218
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-4013
Mailing Address - Country:US
Mailing Address - Phone:920-457-1717
Mailing Address - Fax:
Practice Address - Street 1:130 CARR RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073-9500
Practice Address - Country:US
Practice Address - Phone:920-893-8458
Practice Address - Fax:920-893-8458
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI1002390122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program