Provider Demographics
NPI:1194825950
Name:DEL VALLE, MERCEDES RAQUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MERCEDES
Middle Name:RAQUEL
Last Name:DEL VALLE
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 1:388 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2310
Mailing Address - Country:US
Mailing Address - Phone:541-341-1404
Mailing Address - Fax:541-342-7602
Practice Address - Street 1:388 HIGH ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2310
Practice Address - Country:US
Practice Address - Phone:541-341-1404
Practice Address - Fax:541-342-7602
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2015-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD70301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
004722000OtherBLUE CROSS BLUE SHIELD
OR083001Medicaid
OR7030OtherDELTA DENTAL
000698861OtherUNITED CONCORDIA