Provider Demographics
NPI:1649824475
Name:VALENCIA, JAIME A (DMD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:A
Last Name:VALENCIA
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 1:2575 GLADES CIR STE 2
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-2254
Mailing Address - Country:US
Mailing Address - Phone:954-384-9908
Mailing Address - Fax:
Practice Address - Street 1:1536 EISENHOWER PKWY
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-3130
Practice Address - Country:US
Practice Address - Phone:478-781-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1225621223G0001X, 1223X0400X
FLDN244461223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice