Healthcare Provider Details

I. General information

NPI: 1932362589
Provider Name (Legal Business Name): VALLEY DENTAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 S 2ND ST VALLEY DENTAL CARE
LESUEUR MN
56058-1903
US

IV. Provider business mailing address

219 S 2ND ST VALLEY DENTAL CARE
LESUEUR MN
56058-1903
US

V. Phone/Fax

Practice location:
  • Phone: 507-665-2275
  • Fax: 507-665-6842
Mailing address:
  • Phone: 507-665-2275
  • Fax: 507-665-6842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN MICHAEL DUNN
Title or Position: CEO
Credential: DDS
Phone: 507-665-2275