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NPI Code Detail

MEDICARE: DR. JORGE ELLER VALDES DDS

MEDICARE: DR. JORGE ELLER VALDES DDS
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
1122300000XDentistDI02423000NJ

General Provider Information

NPI Number : 1912230913
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JORGE ELLER VALDES DDS
Provider Business Mailing Address
First Line : 10590 ENDURING FREEDOM DRIVE
Second Line : US ARMY DENTAL HQS FT DRUM
City : FORT DRUM
State : NY
Zip : 13602-5005
Country : US
Telephone Number : 315-772-6234
Fax Number : 315-772-2393
Provider Business Practice Location Address
First Line : 10590 ENDURING FREEDOM DRIVE
Second Line : US ARMY DENTAL HQS FT DRUM
City : FORT DRUM
State : NY
Zip : 13602-5005
Country : US
Telephone Number : 315-772-6234
Fax Number : 315-772-2393
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2009
Last Update Date : 07/20/2012

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