Healthcare Provider Details

I. General information

NPI: 1710048202
Provider Name (Legal Business Name): ABELARDO VALDES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 S PINE ST
GRANTSBURG WI
54840-7930
US

IV. Provider business mailing address

302 S PINE ST
GRANTSBURG WI
54840-7930
US

V. Phone/Fax

Practice location:
  • Phone: 630-819-4181
  • Fax: 520-572-1021
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number009242
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD009621
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6001684-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: