Provider Demographics
NPI:1669443339
Name:VALLEJO, FREDDY (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDDY
Middle Name:
Last Name:VALLEJO
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 1:600 S PINE ISLAND RD
Mailing Address - Street 2:SUIT #201
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3166
Mailing Address - Country:US
Mailing Address - Phone:954-382-0110
Mailing Address - Fax:
Practice Address - Street 1:600 S PINE ISLAND RD
Practice Address - Street 2:SUIT #201
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3166
Practice Address - Country:US
Practice Address - Phone:954-382-0110
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN138631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice