Provider Demographics
NPI:1285237347
Name:CITY BEAUTIFUL ORAL SURGERY & DENTAL IMPLANTS LLC
Entity type:Organization
Organization Name:CITY BEAUTIFUL ORAL SURGERY & DENTAL IMPLANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:407-617-3726
Mailing Address - Street 1:2014 EDGEWATER DR # 190
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5312
Mailing Address - Country:US
Mailing Address - Phone:407-617-3726
Mailing Address - Fax:
Practice Address - Street 1:2101 PARK CENTER DR STE 125
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-7610
Practice Address - Country:US
Practice Address - Phone:407-617-3726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-19
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty