Provider Demographics
NPI:1568247898
Name:DIANE O. VALDEZ D.D.S., A DENTAL CORPORATION
Entity Type:Organization
Organization Name:DIANE O. VALDEZ D.D.S., A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:O
Authorized Official - Last Name:VALDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-302-3322
Mailing Address - Street 1:31515 RANCHO PUEBLO RD STE 204
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-4837
Mailing Address - Country:US
Mailing Address - Phone:951-302-3322
Mailing Address - Fax:951-302-3325
Practice Address - Street 1:31515 RANCHO PUEBLO RD STE 204
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-4837
Practice Address - Country:US
Practice Address - Phone:951-302-3322
Practice Address - Fax:951-302-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty