Provider Demographics
NPI:1396818332
Name:VALENZUELA, ANTHONY ROBERT (DMD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:ROBERT
Last Name:VALENZUELA
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 1:17606 N 59TH AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-9702
Mailing Address - Country:US
Mailing Address - Phone:623-225-7345
Mailing Address - Fax:623-225-7351
Practice Address - Street 1:17606 N 59TH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-9702
Practice Address - Country:US
Practice Address - Phone:623-225-7345
Practice Address - Fax:623-225-7351
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3330AZ1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice