Provider Demographics
NPI:1790343176
Name:VALENCIA, YVETTE (DMD)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:
Last Name:VALENCIA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 WENONAH AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-1040
Mailing Address - Country:US
Mailing Address - Phone:708-228-4331
Mailing Address - Fax:
Practice Address - Street 1:80 N NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3329
Practice Address - Country:US
Practice Address - Phone:847-292-0600
Practice Address - Fax:847-292-0608
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190321371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice