Healthcare Provider Details

I. General information

NPI: 1417647678
Provider Name (Legal Business Name): VALUDENTAL ST JOSEPH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 FREDERICK AVE
SAINT JOSEPH MO
64506-3156
US

IV. Provider business mailing address

4015 FREDERICK AVE
SAINT JOSEPH MO
64506-3156
US

V. Phone/Fax

Practice location:
  • Phone: 816-208-0000
  • Fax: 816-654-6766
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LINDA ESLER
Title or Position: OFFICE MANAGER
Credential:
Phone: 816-208-0000