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General NPI Number Information
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NPI Number | 1952727182
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Entity Type | Organization
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Legal Business Name | VALLEY DENTAL ASSOCIATES, PA
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Dates
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Enumeration Date | 03/12/2014
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Last Update Date | 03/12/2014
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Provider Practice Location Address
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Address Line | 555 BERGEN BLVD
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City | RIDGEFIELD
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State | NJ
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Zip | 07657-2020
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Country | US
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Telephone | 201-945-5777
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Fax | 201-945-5667
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Provider Business Mailing Address
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Address Line | 555 BERGEN BLVD
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City | RIDGEFIELD
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State | NJ
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Zip | 07657-2020
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Country | US
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Telephone | 201-945-5777
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Fax | 201-945-5667
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Authorized Official
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Title or Position | PRES/OWNER
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Name | DR. JOSEPH JOHN PORTALE
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Credential | DMD
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Telephone | 201-945-5777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 22DI00945900
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License Number State | NJ
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