MEDICARE: DR. GARY JAMES VALIANT DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DEN.00201915	CO
2	1223G0001X	General Practice Dentistry	D9560	MN

General Provider Information

NPI Number	:	1285619783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY JAMES VALIANT DDS

Provider Business Mailing Address
First Line	:	1667 COCHRANE CIR BLDG 7495
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4603
Country	:	US
Telephone Number	:	719-526-5537
Fax Number	:

Provider Business Practice Location Address
First Line	:	1667 COCHRANE CIR BLDG 7495
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4603
Country	:	US
Telephone Number	:	719-526-5537
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	06/17/2022

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