Provider Demographics
NPI:1134420755
Name:VALDEZ, CARMEN G (DDS)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:G
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CARMEN
Other - Middle Name:G
Other - Last Name:VALDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:15454 E. GALE AVE STE A HA
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745
Mailing Address - Country:US
Mailing Address - Phone:626-333-3600
Mailing Address - Fax:626-333-3677
Practice Address - Street 1:15454 E. GALE AVE STE A
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745
Practice Address - Country:US
Practice Address - Phone:626-333-3600
Practice Address - Fax:626-333-3677
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48402122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist