MEDICARE: VALDERRAMA AND HUSSAIN LLC

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	261QD0000X	Dental Clinic/Center	22DI02502200	NJ

General Provider Information

NPI Number	:	1407371990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALDERRAMA AND HUSSAIN LLC

Provider Business Mailing Address
First Line	:	3538 STATE ROUTE 27
Second Line	:
City	:	KENDALL PARK
State	:	NJ
Zip	:	08824-1050
Country	:	US
Telephone Number	:	732-821-8585
Fax Number	:

Provider Business Practice Location Address
First Line	:	3538 STATE ROUTE 27
Second Line	:
City	:	KENDALL PARK
State	:	NJ
Zip	:	08824-1050
Country	:	US
Telephone Number	:	732-821-8585
Fax Number	:

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	DR. ALAN R VALDERRAMA
Credential	:	DMD
Telephone Number	:	732-821-8585

Provider Enumeration Date	:	08/07/2017
Last Update Date	:	07/21/2022

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