Provider Demographics
NPI:1508038290
Name:DELVALLE, JESUS ENRIQUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:ENRIQUE
Last Name:DELVALLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 S DOUGLAS RD APT 213
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4620
Mailing Address - Country:US
Mailing Address - Phone:305-442-1094
Mailing Address - Fax:786-497-1725
Practice Address - Street 1:2030 S DOUGLAS RD APT 213
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4620
Practice Address - Country:US
Practice Address - Phone:305-442-1094
Practice Address - Fax:786-497-1725
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0012142122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist