Provider Demographics
NPI:1194365015
Name:VALADEZ DENTAL CORP
Entity Type:Organization
Organization Name:VALADEZ DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-353-2038
Mailing Address - Street 1:2650 CAMINO DEL RIO N STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1630
Mailing Address - Country:US
Mailing Address - Phone:619-298-0521
Mailing Address - Fax:619-298-0661
Practice Address - Street 1:2650 CAMINO DEL RIO N STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1630
Practice Address - Country:US
Practice Address - Phone:619-298-0521
Practice Address - Fax:619-298-0661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental