Healthcare Provider Details

I. General information

NPI: 1851507008
Provider Name (Legal Business Name): VALLEY ORTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 SCOTT SWAMP RD
FARMINGTON CT
06032-3448
US

IV. Provider business mailing address

353 SCOTT SWAMP RD
FARMINGTON CT
06032-3448
US

V. Phone/Fax

Practice location:
  • Phone: 860-678-7899
  • Fax: 860-678-7890
Mailing address:
  • Phone: 860-678-7899
  • Fax: 860-678-7890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number008282
License Number StateCT

VIII. Authorized Official

Name: DR. BALIRAM MARAJ
Title or Position: DOCTOR
Credential: D.M.D.,M.D.S
Phone: 860-678-7899