Active NPI
Edgar G Valderrama, DDS
- General Practice Dentistry
- Tucson, AZ
National Provider Identifier
1487769329
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4242
- Practice address
- 2934 W Ina Rd
Tucson, AZ 85741-2110 - Phone
- (520) 742-9500
- Fax
- (520) 877-9500
- NPI assigned
- Aug 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4242 | AZ | Primary |
Addresses
Primary practice location
2934 W Ina Rd
Tucson, AZ 85741-2110
Mailing address
2934 W Ina Rd
Tucson, AZ 85741-2110
Phone (520) 742-9500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4242 | AZ | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Western Dental of Arizona, Inc. | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Tucson, AZ
- NPI 1215073168
General Practice
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307404800000",
"number": "1487769329",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2934 W INA RD",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857412110",
"telephone_number": "520-742-9500",
"fax_number": "520-877-9500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2934 W INA RD",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857412110",
"telephone_number": "520-742-9500",
"fax_number": "520-877-9500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VALDERRAMA",
"first_name": "EDGAR",
"middle_name": "G",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-20",
"last_updated": "2011-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AZ",
"license": "4242",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.