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General NPI Number Information
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NPI Number | 1508072851
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Entity Type | Organization
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Legal Business Name | VALLEY DENTAL L.L.C.
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 953 E ELLIOT RD SUITE 102
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City | TEMPE
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State | AZ
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Zip | 85284-1561
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Country | US
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Telephone | 480-839-7996
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Fax | 480-752-3231
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Provider Business Mailing Address
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Address Line | 953 E ELLIOT RD SUITE 102
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City | TEMPE
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State | AZ
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Zip | 85284-1561
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Country | US
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Telephone | 480-839-7996
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Fax | 480-752-3231
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MARISA MEDLOCK
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Credential |
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Telephone | 480-839-7996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D6107
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License Number State | AZ
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