MEDICARE: DAVID VALENTA DDS AND MADELAINE DRISKILL DMD PLLC

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	332BC3200X	Customized Equipment (DME)
2	122300000X	Dentist

General Provider Information

NPI Number	:	1841871092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID VALENTA DDS AND MADELAINE DRISKILL DMD PLLC

Provider Business Mailing Address
First Line	:	1508 N ROYER ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-7634
Country	:	US
Telephone Number	:	704-288-6736
Fax Number	:

Provider Business Practice Location Address
First Line	:	1975 DOMINION WAY STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1481
Country	:	US
Telephone Number	:	719-388-8700
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID VALENTA
Credential	:	DDS
Telephone Number	:	704-288-6736

Provider Enumeration Date	:	04/19/2021
Last Update Date	:	04/16/2024

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