MEDICARE: DR. JUAN C VALENCIA DMD

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	D7312	AZ

General Provider Information

NPI Number	:	1376738385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN C VALENCIA DMD

Provider Business Mailing Address
First Line	:	7780 E. SPEEDWAY BLVD.
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-1606
Country	:	US
Telephone Number	:	520-979-3880
Fax Number	:

Provider Business Practice Location Address
First Line	:	7780 E. SPEEDWAY BLVD.
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-1606
Country	:	US
Telephone Number	:	520-979-3880
Fax Number	:

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

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	09/30/2013

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