Provider Demographics
NPI:1699493940
Name:VEGA- VALBUENA, NICOLE ALEXANDRA (DDS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ALEXANDRA
Last Name:VEGA- VALBUENA
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 1:3229 ORCUTT RD APT 100
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-2393
Mailing Address - Country:US
Mailing Address - Phone:954-598-2387
Mailing Address - Fax:
Practice Address - Street 1:238 E BETTERAVIA RD STE D
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7889
Practice Address - Country:US
Practice Address - Phone:805-220-9268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1079631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty