Provider Demographics
NPI:1578118758
Name:SOMOZA-VALLE, DAVID ELEAZER (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ELEAZER
Last Name:SOMOZA-VALLE
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 1:3574 DESERT CLIFF ST UNIT 203
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-8673
Mailing Address - Country:US
Mailing Address - Phone:305-384-0161
Mailing Address - Fax:
Practice Address - Street 1:6485 N DECATUR BLVD STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-2989
Practice Address - Country:US
Practice Address - Phone:702-577-1941
Practice Address - Fax:702-832-1495
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV76151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice