Provider Demographics
NPI:1306628482
Name:VALDIVIASMILES
Entity type:Organization
Organization Name:VALDIVIASMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDIVIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-952-4003
Mailing Address - Street 1:9554 OLD KEENE MILL RD STE C
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-4287
Mailing Address - Country:US
Mailing Address - Phone:703-952-4003
Mailing Address - Fax:571-281-0001
Practice Address - Street 1:9554 OLD KEENE MILL RD STE C
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-4287
Practice Address - Country:US
Practice Address - Phone:703-952-4003
Practice Address - Fax:571-281-0001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty