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General NPI Number Information
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NPI Number | 1366835282
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Entity Type | Organization
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Legal Business Name | DR. MARCO A. DEL VALLE, OFICINA DENTAL CSP
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Dates
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Enumeration Date | 03/17/2015
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Last Update Date | 03/17/2015
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Provider Practice Location Address
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Address Line | 51 CALLE ESTACION
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City | AGUADA
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State | PR
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Zip | 00602-3247
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Country | US
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Telephone | 787-868-7770
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 835
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City | AGUADA
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State | PR
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Zip | 00602-0835
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Country | US
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Telephone | 787-868-7770
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Fax | 787-868-7770
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Authorized Official
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Title or Position | GENERAL DENTIS
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Name | DR. MARCO ANTONIO DEL VALLE
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Credential | D.D.S
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Telephone | 787-868-7770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 1828
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License Number State | PR
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