Provider Demographics
NPI:1649605585
Name:VALDES, MARTHA BEATRIZ (DDS)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:BEATRIZ
Last Name:VALDES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 W 52ND ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4018
Mailing Address - Country:US
Mailing Address - Phone:786-337-1320
Mailing Address - Fax:
Practice Address - Street 1:7800 N UNIVERSITY DR
Practice Address - Street 2:SUITE 101-102
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2128
Practice Address - Country:US
Practice Address - Phone:954-670-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN20482122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010843000Medicaid