Provider Demographics
NPI:1104083914
Name:VALDES, RAFAEL JORGE (DDSPA)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:JORGE
Last Name:VALDES
Suffix:
Gender:M
Credentials:DDSPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7755 SW 87TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2534
Mailing Address - Country:US
Mailing Address - Phone:305-595-1774
Mailing Address - Fax:305-274-1712
Practice Address - Street 1:7755 SW 87TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2534
Practice Address - Country:US
Practice Address - Phone:305-595-1774
Practice Address - Fax:305-274-1712
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00118911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice