Provider Demographics
NPI:1386257178
Name:DR NELLY VALENCIA DDS PA
Entity type:Organization
Organization Name:DR NELLY VALENCIA DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PA
Authorized Official - Phone:305-649-4242
Mailing Address - Street 1:4011 W FLAGLER ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1643
Mailing Address - Country:US
Mailing Address - Phone:305-649-4242
Mailing Address - Fax:305-508-6620
Practice Address - Street 1:4011 W FLAGLER ST STE 201
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1643
Practice Address - Country:US
Practice Address - Phone:305-649-4242
Practice Address - Fax:305-508-6620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty