Provider Demographics
NPI:1982265617
Name:VARELA, JOSE R (DDS)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:R
Last Name:VARELA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 GLENNSTONE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-6417
Mailing Address - Country:US
Mailing Address - Phone:650-218-6070
Mailing Address - Fax:
Practice Address - Street 1:441 S MORGAN ST
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-5123
Practice Address - Country:US
Practice Address - Phone:336-599-6641
Practice Address - Fax:336-599-7182
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11505122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11505OtherNORTH CAROLINA STATE BOARD OF DENTAL EXAMINERS