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General NPI Number Information
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NPI Number | 1043929623
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Entity Type | Organization
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Legal Business Name | VALENZUELA DENTAL LLC
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Dates
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Enumeration Date | 11/22/2022
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Last Update Date | 11/22/2022
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Provider Practice Location Address
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Address Line | 2585 S NELLIS BLVD STE 6
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City | LAS VEGAS
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State | NV
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Zip | 89121-7548
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Country | US
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Telephone | 702-641-0481
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Fax |
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Provider Business Mailing Address
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Address Line | 1930 VILLAGE CENTER CIR SUITE 3 PMB 429
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City | LAS VEGAS
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State | NV
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Zip | 89134
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LLUVIA VALENZUELA
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Credential | DMD
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Telephone | 702-641-0481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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