Provider Demographics
NPI:1720822984
Name:VALDEZ, JUVENTINO (DDS)
Entity type:Individual
Prefix:
First Name:JUVENTINO
Middle Name:
Last Name:VALDEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 MERLE ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77502-3721
Mailing Address - Country:US
Mailing Address - Phone:713-505-3815
Mailing Address - Fax:
Practice Address - Street 1:1309 E NOLANA AVE STE 3
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6189
Practice Address - Country:US
Practice Address - Phone:956-616-4911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-22
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX406221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice