Provider Demographics
NPI:1366835282
Name:DR. MARCO A. DEL VALLE, OFICINA DENTAL CSP
Entity Type:Organization
Organization Name:DR. MARCO A. DEL VALLE, OFICINA DENTAL CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIS
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:DEL VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:787-868-7770
Mailing Address - Street 1:PO BOX 835
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-0835
Mailing Address - Country:US
Mailing Address - Phone:787-868-7770
Mailing Address - Fax:787-868-7770
Practice Address - Street 1:51 CALLE ESTACION
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-3247
Practice Address - Country:US
Practice Address - Phone:787-868-7770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1828261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2073OtherPUERTO RICO DEPARTMENT OF STATE