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General NPI Number Information
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NPI Number | 1063861607
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Entity Type | Individual
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Provider Name | GRETCHEN DE VALES
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Gender | Female
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Dates
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Enumeration Date | 06/05/2016
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 2275 S FEDERAL HWY STE 310
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City | DELRAY BEACH
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State | FL
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Zip | 33483-3332
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Country | US
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Telephone | 561-894-4299
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Fax |
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Provider Business Mailing Address
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Address Line | 2275 S FEDERAL HWY STE 310
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City | DELRAY BEACH
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State | FL
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Zip | 33483-3332
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Country | US
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Telephone | 561-894-4299
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN26197
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License Number State | FL
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