Healthcare Provider Details

I. General information

NPI: 1295852002
Provider Name (Legal Business Name): VALERIE A DAVID D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

372 CHANDLER ST SUITE 10
WORCESTER MA
01602-3300
US

IV. Provider business mailing address

372 CHANDLER ST SUITE 10
WORCESTER MA
01602-3300
US

V. Phone/Fax

Practice location:
  • Phone: 508-754-5226
  • Fax: 508-754-5228
Mailing address:
  • Phone: 508-754-5226
  • Fax: 508-754-5228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number20721
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: