Provider Demographics
NPI:1073346433
Name:VALLADARES SUAREZ, KATIA (DMD)
Entity type:Individual
Prefix:
First Name:KATIA
Middle Name:
Last Name:VALLADARES SUAREZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 NE 12TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-1660
Mailing Address - Country:US
Mailing Address - Phone:305-450-0852
Mailing Address - Fax:
Practice Address - Street 1:260 BETH STACEY BLVD
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6074
Practice Address - Country:US
Practice Address - Phone:239-230-8161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29554122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist