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General NPI Number Information
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NPI Number | 1811395767
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Entity Type | Organization
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Legal Business Name | MARIO G. VALDEZ D.D.S., PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 12/09/2014
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Last Update Date | 12/09/2014
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Provider Practice Location Address
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Address Line | 1500 N GRAND AVE SUITE 102
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City | SANTA ANA
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State | CA
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Zip | 92701-2611
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Country | US
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Telephone | 714-667-5946
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Fax | 714-667-6935
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Provider Business Mailing Address
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Address Line | 1500 N GRAND AVE SUITE 102
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City | SANTA ANA
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State | CA
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Zip | 92701-2611
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Country | US
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Telephone | 714-667-5946
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Fax | 714-667-6935
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. MARIO GUILLERMO VALDEZ
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Credential | D.D.S.
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Telephone | 714-667-5946
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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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