MEDICARE: DR. JOSE MANUEL DELVALLE D.D.S.,P.A

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	DN10269	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912052382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE MANUEL DELVALLE D.D.S.,P.A

Provider Business Mailing Address
First Line	:	3918 W 12TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4105
Country	:	US
Telephone Number	:	305-556-1770
Fax Number	:

Provider Business Practice Location Address
First Line	:	3918 W 12TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4105
Country	:	US
Telephone Number	:	305-556-1770
Fax Number	:

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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