Provider Demographics
NPI:1356403240
Name:DEL VALLE, ERNESTO (DMD)
Entity type:Individual
Prefix:
First Name:ERNESTO
Middle Name:
Last Name:DEL VALLE
Suffix:
Gender:M
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 655
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00676
Mailing Address - Country:US
Mailing Address - Phone:787-252-0125
Mailing Address - Fax:787-252-4266
Practice Address - Street 1:AVENIDA NATIVO ALERS EDIFICIO COPPELIA
Practice Address - Street 2:SUITE 110
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-252-0125
Practice Address - Fax:787-252-4266
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1341122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist