Provider Demographics
NPI:1104203942
Name:VALLEJOS CASTILLO, MARIA VERONICA (DDS)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:VERONICA
Last Name:VALLEJOS CASTILLO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6316 26TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-2427
Mailing Address - Country:US
Mailing Address - Phone:786-510-5254
Mailing Address - Fax:
Practice Address - Street 1:2911 2ND AVE STE 106
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-5120
Practice Address - Country:US
Practice Address - Phone:786-510-5254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ390200000X
WA611455001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program