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General NPI Number Information
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NPI Number | 1043364698
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Entity Type | Organization
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Legal Business Name | VALLEY DENTAL ASSOCIATES LLC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 07/30/2010
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Provider Practice Location Address
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Address Line | 9199 REISTERSTOWN RD SUITE 206 B
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City | OWINGS MILLS
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State | MD
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Zip | 21117-4520
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Country | US
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Telephone | 410-363-2525
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Fax |
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Provider Business Mailing Address
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Address Line | 9199 REISTERSTOWN RD SUITE 206 B
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City | OWINGS MILLS
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State | MD
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Zip | 21117-4520
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Country | US
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Telephone | 410-363-2525
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Fax |
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Authorized Official
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Title or Position | INSURANCE DIRECTOR
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Name | MICHAEL J. COLE
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Credential |
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Telephone | 727-726-1611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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