Healthcare Provider Details

I. General information

NPI: 1144701103
Provider Name (Legal Business Name): VALER DENTAL COORS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 COORS BLVD NW
ALBUQUERQUE NM
87121-1152
US

IV. Provider business mailing address

2116 HINKLE ST SE
ALBUQUERQUE NM
87102-4930
US

V. Phone/Fax

Practice location:
  • Phone: 216-904-2805
  • Fax:
Mailing address:
  • Phone: 121-690-4280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number03407927000
License Number StateNM

VIII. Authorized Official

Name: MARSHALL KING
Title or Position: HR & FINANCE DIRECTOR
Credential:
Phone: 505-263-8690