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General NPI Number Information
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NPI Number | 1861728339
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Entity Type | Organization
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Legal Business Name | JOHNSON & VALENTA FAMILY DENTISTRY SC
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Dates
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Enumeration Date | 10/19/2009
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Last Update Date | 11/01/2009
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Provider Practice Location Address
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Address Line | 1838 DUNLAP AVE
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City | MARINETTE
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State | WI
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Zip | 54143-1722
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Country | US
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Telephone | 715-735-5626
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Fax | 715-735-3283
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Provider Business Mailing Address
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Address Line | PO BOX 480 1838 DUNLAP AVE
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City | MARINETTE
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State | WI
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Zip | 54143-0480
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Country | US
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Telephone | 715-735-5626
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Fax | 715-735-3283
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDAL L VALENTA
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Credential | DDS
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Telephone | 715-735-5626
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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 | 5537
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License Number State | WI
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