Jorge Eller Valdes, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DI02423000 Issued in NJ

Practice address

10590 Enduring Freedom Drive
US Army Dental HQS Ft Drum
Fort Drum, NY 13602-5005

Phone

(315) 772-6234

Fax

(315) 772-2393

NPI assigned

Sep 9, 2009

Last updated

Jul 20, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1252454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342742400000",
    "number": "1912230913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10590 ENDURING FREEDOM DRIVE",
            "address_2": "US ARMY DENTAL HQS FT DRUM",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "136025005",
            "telephone_number": "315-772-6234",
            "fax_number": "315-772-2393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10590 ENDURING FREEDOM DRIVE",
            "address_2": "US ARMY DENTAL HQS FT DRUM",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "136025005",
            "telephone_number": "315-772-6234",
            "fax_number": "315-772-2393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALDES",
        "first_name": "JORGE",
        "middle_name": "ELLER",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-09",
        "last_updated": "2012-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "DI02423000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly J Twigg, DPT
• Laura Ann Twist, PT
• US Army
• US Army
• Usv Optical Inc.
• Shannon Valencia, BCBA
• Elizabeth Vanslyke, PHARMD
• Igor Vasilj, PH.D.
• Mary Carmen Vazquez, LCSW
• Lauren Veccia-Smith, PA

• Dentist in Fort Drum, NY
• Providers in Fort Drum, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.