Provider Demographics
NPI:1750807970
Name:VALDEZ, MARIA SOCORRO ILAGAN (DDS)
Entity type:Individual
Prefix:
First Name:MARIA SOCORRO
Middle Name:ILAGAN
Last Name:VALDEZ
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 1:2594 NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132
Mailing Address - Country:US
Mailing Address - Phone:408-799-4490
Mailing Address - Fax:
Practice Address - Street 1:242 LA PALA DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-2103
Practice Address - Country:US
Practice Address - Phone:510-659-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1016491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice