Healthcare Provider Details

I. General information

NPI: 1255729281
Provider Name (Legal Business Name): VALERI ORTHODONTICS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2014
Last Update Date: 12/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9020 76TH ST STE B
PLEASANT PRAIRIE WI
53158-1976
US

IV. Provider business mailing address

9020 76TH ST STE B
PLEASANT PRAIRIE WI
53158-1976
US

V. Phone/Fax

Practice location:
  • Phone: 262-577-5242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7051-15
License Number StateWI

VIII. Authorized Official

Name: DR. NICHOLAS VALERI
Title or Position: OWNER
Credential: DDS, MS
Phone: 262-577-5242