MEDICARE: VALENZUELA DENTAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1043929623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALENZUELA DENTAL LLC

Provider Business Mailing Address
First Line	:	1930 VILLAGE CENTER CIR
Second Line	:	SUITE 3 PMB 429
City	:	LAS VEGAS
State	:	NV
Zip	:	89134
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2585 S NELLIS BLVD STE 6
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7548
Country	:	US
Telephone Number	:	702-641-0481
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LLUVIA VALENZUELA
Credential	:	DMD
Telephone Number	:	702-641-0481

Provider Enumeration Date	:	11/22/2022
Last Update Date	:	11/22/2022

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