Provider Demographics
NPI:1194456939
Name:VALENZUELA, ABRAHAM ROBERTO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:ROBERTO
Last Name:VALENZUELA
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 1:347 FALCON RUN
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-4526
Mailing Address - Country:US
Mailing Address - Phone:304-322-0924
Mailing Address - Fax:
Practice Address - Street 1:3090 MORGANTOWN RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:PA
Practice Address - Zip Code:15478-1725
Practice Address - Country:US
Practice Address - Phone:724-569-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS043719122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist