Provider Demographics
NPI:1629630538
Name:VALENCIA, RUBEN JR (DMD)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:
Last Name:VALENCIA
Suffix:JR
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 1:5901 W BEHREND DR APT 1028
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6935
Mailing Address - Country:US
Mailing Address - Phone:619-961-9184
Mailing Address - Fax:
Practice Address - Street 1:5045 W BASELINE RD STE 135
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-7394
Practice Address - Country:US
Practice Address - Phone:602-237-0613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD010367122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist