Provider Demographics
NPI:1376738385
Name:VALENCIA, JUAN C (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:C
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7780 E. SPEEDWAY BLVD.
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1606
Mailing Address - Country:US
Mailing Address - Phone:520-979-3880
Mailing Address - Fax:
Practice Address - Street 1:7780 E. SPEEDWAY BLVD.
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1606
Practice Address - Country:US
Practice Address - Phone:520-979-3880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD73121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice