Provider Demographics
NPI:1871799643
Name:VALDES, CARLOS M (DMD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:M
Last Name:VALDES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W 15TH ST APT 5FE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6736
Mailing Address - Country:US
Mailing Address - Phone:212-929-0080
Mailing Address - Fax:212-929-0080
Practice Address - Street 1:471 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6021
Practice Address - Country:US
Practice Address - Phone:212-929-0080
Practice Address - Fax:212-929-0080
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0446921223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics