Provider Demographics
NPI:1811395767
Name:MARIO G. VALDEZ D.D.S., PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MARIO G. VALDEZ D.D.S., PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:GUILLERMO
Authorized Official - Last Name:VALDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-667-5946
Mailing Address - Street 1:1500 N GRAND AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2611
Mailing Address - Country:US
Mailing Address - Phone:714-667-5946
Mailing Address - Fax:714-667-6935
Practice Address - Street 1:1500 N GRAND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2611
Practice Address - Country:US
Practice Address - Phone:714-667-5946
Practice Address - Fax:714-667-6935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty