1265466049 NPI number — JOHN ERIC VALENCIA DMD

Table of content: JOHN ERIC VALENCIA DMD (NPI 1265466049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265466049 NPI number — JOHN ERIC VALENCIA DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VALENCIA
Provider First Name:
JOHN
Provider Middle Name:
ERIC
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265466049
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1245 S CEDAR CREST BLVD
Provider Second Line Business Mailing Address:
STE 206
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-821-1130
Provider Business Mailing Address Fax Number:
610-821-7705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1245 S CEDAR CREST BLVD
Provider Second Line Business Practice Location Address:
STE 206
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-821-1130
Provider Business Practice Location Address Fax Number:
610-821-7705
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DS030015 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 956129 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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