Provider Demographics
NPI:1366020919
Name:ADDISON VALDES, GEENA (DMD)
Entity Type:Individual
Prefix:
First Name:GEENA
Middle Name:
Last Name:ADDISON VALDES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 CENTER DR RM D1-17
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-3006
Mailing Address - Country:US
Mailing Address - Phone:352-273-5440
Mailing Address - Fax:352-273-5446
Practice Address - Street 1:1395 CENTER DR RM D1-17
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3006
Practice Address - Country:US
Practice Address - Phone:352-273-5440
Practice Address - Fax:352-273-5446
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN258891223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program