Provider Demographics
NPI:1194075309
Name:VALENZUELA, TIRZA PAOLA (DDS)
Entity type:Individual
Prefix:DR
First Name:TIRZA
Middle Name:PAOLA
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 1:2925 WIGWAM PKWY
Mailing Address - Street 2:#112
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-2871
Mailing Address - Country:US
Mailing Address - Phone:917-992-9767
Mailing Address - Fax:
Practice Address - Street 1:953 E SAHARA AVE
Practice Address - Street 2:#A2
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3005
Practice Address - Country:US
Practice Address - Phone:702-794-0304
Practice Address - Fax:702-733-0377
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6301122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist