Provider Demographics
NPI:1013008978
Name:SPRING VALLEY DENTAL GROUP LTD
Entity Type:Organization
Organization Name:SPRING VALLEY DENTAL GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP SEC
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:V
Authorized Official - Last Name:OGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-632-8471
Mailing Address - Street 1:904 E HIGHWAY 50
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269
Mailing Address - Country:US
Mailing Address - Phone:618-632-8471
Mailing Address - Fax:618-632-7130
Practice Address - Street 1:904 E HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269
Practice Address - Country:US
Practice Address - Phone:618-632-8471
Practice Address - Fax:618-632-7130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
507401OtherUNITED CONCORDIA INS