Provider Demographics
NPI:1013126283
Name:VALENTIN PONCE, WALESKA (DMD)
Entity type:Individual
Prefix:MRS
First Name:WALESKA
Middle Name:
Last Name:VALENTIN PONCE
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:PO BOX 1195
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-1195
Mailing Address - Country:US
Mailing Address - Phone:787-854-1954
Mailing Address - Fax:
Practice Address - Street 1:BO CANTERA # 65
Practice Address - Street 2:CARR. #2 KM 44.2
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-1954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2360OtherSTATE LICENSE