Provider Demographics
NPI:1629727987
Name:VALDEZ, JOANNA (DD)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:DD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 WARREN ST APT 219
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-4250
Mailing Address - Country:US
Mailing Address - Phone:347-319-7081
Mailing Address - Fax:
Practice Address - Street 1:47 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-7308
Practice Address - Country:US
Practice Address - Phone:347-319-7081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL151391223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health