Provider Demographics
NPI: | 1720312333 |
---|---|
Name: | ROEL VALADEZ, JR., D.D.S., P.L.L.C. |
Entity Type: | Organization |
Organization Name: | ROEL VALADEZ, JR., D.D.S., P.L.L.C. |
Other - Org Name: | ADVANCED DENTAL CARE OF SOUTH TEXAS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | MANAGER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | ROEL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | VALADEZ |
Authorized Official - Suffix: | JR |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 361-664-3057 |
Mailing Address - Street 1: | 80 N WOODLAWN DR |
Mailing Address - Street 2: | |
Mailing Address - City: | ALICE |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78332-5000 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 361-664-3057 |
Mailing Address - Fax: | 361-664-4556 |
Practice Address - Street 1: | 80 N WOODLAWN DR |
Practice Address - Street 2: | |
Practice Address - City: | ALICE |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78332-5000 |
Practice Address - Country: | US |
Practice Address - Phone: | 361-664-3057 |
Practice Address - Fax: | 361-664-4556 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-09-29 |
Last Update Date: | 2014-06-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Single Specialty |