Provider Demographics
NPI:1689681108
Name:VALDES, VIVIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:
Last Name:VALDES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6840 BIRD RD
Mailing Address - Street 2:SUITE 207-A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3762
Mailing Address - Country:US
Mailing Address - Phone:305-669-6111
Mailing Address - Fax:305-669-6160
Practice Address - Street 1:6840 BIRD RD
Practice Address - Street 2:SUITE 207-A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3762
Practice Address - Country:US
Practice Address - Phone:305-669-6111
Practice Address - Fax:305-669-6160
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0014228122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist