Provider Demographics
NPI:1881644235
Name:VALDEZ DETELLO, EDITH (RDH)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:VALDEZ DETELLO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:EDIE
Other - Middle Name:
Other - Last Name:VALDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:23508 E OHAWA PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016
Mailing Address - Country:US
Mailing Address - Phone:303-307-9076
Mailing Address - Fax:
Practice Address - Street 1:1055 CLERMONT ST
Practice Address - Street 2:DENTAL 160 DEPT OF VETERANS AFFAIRS ECHCS
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220
Practice Address - Country:US
Practice Address - Phone:303-393-2823
Practice Address - Fax:303-393-4632
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3013124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06000008OtherVA