Provider Demographics
NPI:1669810693
Name:VALLE, JORGE JAVIER (DMD, MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:JAVIER
Last Name:VALLE
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 EDGEWATER DR # 190
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2101 PARK CENTER DR STE 125
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-7610
Practice Address - Country:US
Practice Address - Phone:407-617-3726
Practice Address - Fax:321-273-5108
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1379741223S0112X, 1223S0112X
FLDN20336204E00000X, 1223S0112X
OK2081223S0112X
OK34080208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery