Provider Demographics
NPI:1063601631
Name:VALENZUELA, ODALYS (DDS)
Entity type:Individual
Prefix:DR
First Name:ODALYS
Middle Name:
Last Name:VALENZUELA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4355 W 16TH AVE STE 205A
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7668
Mailing Address - Country:US
Mailing Address - Phone:305-824-9199
Mailing Address - Fax:305-824-8885
Practice Address - Street 1:4355 W 16TH AVE STE 205A
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7668
Practice Address - Country:US
Practice Address - Phone:305-824-9199
Practice Address - Fax:305-824-8885
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL157551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice