Healthcare Provider Details

I. General information

NPI: 1376712968
Provider Name (Legal Business Name): WARREN VALLERAND, DDS, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40399 GRAND RIVER AVE SUITE 140
NOVI MI
48375-2148
US

IV. Provider business mailing address

40399 GRAND RIVER AVE SUITE 140
NOVI MI
48375-2148
US

V. Phone/Fax

Practice location:
  • Phone: 248-478-7200
  • Fax: 248-478-7237
Mailing address:
  • Phone: 248-478-7200
  • Fax: 248-478-7237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberWV017431
License Number StateMI

VIII. Authorized Official

Name: DR. WARREN P VALLERAND
Title or Position: SURGEON
Credential: DDS, MD
Phone: 248-478-7200