Provider Demographics
NPI:1174179436
Name:VALENCIA BAEZ, ALVARO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALVARO
Middle Name:
Last Name:VALENCIA BAEZ
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 1:3025 MCHENRY AVE
Mailing Address - Street 2:STE N
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-1449
Mailing Address - Country:US
Mailing Address - Phone:209-337-4777
Mailing Address - Fax:
Practice Address - Street 1:333 SAN CARLOS WAY STE A
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-2037
Practice Address - Country:US
Practice Address - Phone:209-536-8333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1037681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty