Provider Demographics
NPI:1285182592
Name:VALLE TOLIMA DENTAL CARE LLC
Entity Type:Organization
Organization Name:VALLE TOLIMA DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-744-7747
Mailing Address - Street 1:PO BOX 1747
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-1747
Mailing Address - Country:US
Mailing Address - Phone:787-744-7747
Mailing Address - Fax:787-703-3220
Practice Address - Street 1:A15 AVE PRINCIPAL OESTE
Practice Address - Street 2:DEL RIO SHOPPING CENTER
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-744-7747
Practice Address - Fax:787-703-3220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1656261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental