Healthcare Provider Details

I. General information

NPI: 1639970064
Provider Name (Legal Business Name): BRANDON OMAR VALERIO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 DEL PRADO BLVD S
CAPE CORAL FL
33990-1710
US

IV. Provider business mailing address

13991 SW 154TH CT
MIAMI FL
33196-6035
US

V. Phone/Fax

Practice location:
  • Phone: 239-314-1616
  • Fax:
Mailing address:
  • Phone: 305-979-5508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN30525
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: