Provider Demographics
NPI:1922430487
Name:SO & VALDEZ, A PROFESSIONAL DENTAL CORPORATIOM
Entity Type:Organization
Organization Name:SO & VALDEZ, A PROFESSIONAL DENTAL CORPORATIOM
Other - Org Name:PEDIATRIC ORAL WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:TING
Authorized Official - Last Name:SO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-418-3519
Mailing Address - Street 1:847 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1602
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:847 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1602
Practice Address - Country:US
Practice Address - Phone:510-418-3519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA584081223P0221X
CA592711223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty