Provider Demographics
NPI:1780643460
Name:VALLADARES, CARLOS ALBERTO (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ALBERTO
Last Name:VALLADARES
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 1:5358 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-2317
Mailing Address - Country:US
Mailing Address - Phone:702-739-9548
Mailing Address - Fax:702-139-9845
Practice Address - Street 1:5358 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-2317
Practice Address - Country:US
Practice Address - Phone:702-739-9548
Practice Address - Fax:702-139-9845
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9211223G0001X
TX27627122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist