MEDICARE: DR. JON VALDINA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	027799	NY

General Provider Information

NPI Number	:	1316941693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JON VALDINA D.D.S.

Provider Business Mailing Address
First Line	:	188 GENESEE ST
Second Line	:	STE 216
City	:	AUBURN
State	:	NY
Zip	:	13021-3326
Country	:	US
Telephone Number	:	315-253-3000
Fax Number	:	315-253-7888

Provider Business Practice Location Address
First Line	:	188 GENESEE ST
Second Line	:	STE 216
City	:	AUBURN
State	:	NY
Zip	:	13021-3326
Country	:	US
Telephone Number	:	315-253-3000
Fax Number	:	315-253-7888

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	07/08/2007

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