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General NPI Number Information
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NPI Number | 1780102426
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Entity Type | Organization
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Legal Business Name | MARAI VALES, DMD, LLC
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Dates
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Enumeration Date | 09/01/2017
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Last Update Date | 09/01/2017
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Provider Practice Location Address
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Address Line | 8525 DR MARTIN LUTHER KING JR ST N
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City | SAINT PETERSBURG
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State | FL
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Zip | 33702-3505
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Country | US
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Telephone | 727-914-6611
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Fax |
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Provider Business Mailing Address
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Address Line | 8525 DR MARTIN LUTHER KING JR ST N
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City | SAINT PETERSBURG
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State | FL
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Zip | 33702-3505
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Country | US
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Telephone | 727-914-6611
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Fax | 727-914-6512
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Authorized Official
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Title or Position | OWNER
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Name | ANA MARAI VALES
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Credential | DMD
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Telephone | 727-914-6611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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