Provider Demographics
NPI:1952571150
Name:VALADEZ, DOMINGO (DDS,MSD)
Entity Type:Individual
Prefix:DR
First Name:DOMINGO
Middle Name:
Last Name:VALADEZ
Suffix:
Gender:M
Credentials:DDS,MSD
Other - Prefix:DR
Other - First Name:ELENA
Other - Middle Name:D
Other - Last Name:VALADEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS,MSD
Mailing Address - Street 1:5529 N MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2244
Mailing Address - Country:US
Mailing Address - Phone:956-630-2701
Mailing Address - Fax:956-630-2703
Practice Address - Street 1:5529 N MCCOLL RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2244
Practice Address - Country:US
Practice Address - Phone:956-630-2701
Practice Address - Fax:956-630-2703
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX168801223P0700X
TX168811223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics