Provider Demographics
NPI:1003675976
Name:VALENCE DENTAL, PLLC
Entity Type:Organization
Organization Name:VALENCE DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-610-3505
Mailing Address - Street 1:1630 SW WHITE BIRCH CIR
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-7213
Mailing Address - Country:US
Mailing Address - Phone:515-965-4470
Mailing Address - Fax:
Practice Address - Street 1:1630 SW WHITE BIRCH CIR
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-7213
Practice Address - Country:US
Practice Address - Phone:515-965-4470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty