MEDICARE: DR. CARLOS ALBERTO VALLADARES 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	921	NV
2	122300000X	Dentist	27627	TX

General Provider Information

NPI Number	:	1780643460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS ALBERTO VALLADARES D.D.S.

Provider Business Mailing Address
First Line	:	5358 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-2317
Country	:	US
Telephone Number	:	702-739-9548
Fax Number	:	702-139-9845

Provider Business Practice Location Address
First Line	:	5358 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-2317
Country	:	US
Telephone Number	:	702-739-9548
Fax Number	:	702-139-9845

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	01/24/2012

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