Provider Demographics
NPI:1063555258
Name:VENTURENA, VICTOR J (DMD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:J
Last Name:VENTURENA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-4331
Mailing Address - Country:US
Mailing Address - Phone:302-656-0558
Mailing Address - Fax:302-658-5947
Practice Address - Street 1:1117 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-4331
Practice Address - Country:US
Practice Address - Phone:302-656-0558
Practice Address - Fax:302-658-5947
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE20021024531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice