Provider Demographics
NPI:1093874638
Name:VALPARAISO FAMILY DENTISTRY PC
Entity Type:Organization
Organization Name:VALPARAISO FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BEHREND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-531-9293
Mailing Address - Street 1:2005 ROOSEVELT RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2746
Mailing Address - Country:US
Mailing Address - Phone:219-531-9293
Mailing Address - Fax:219-531-0537
Practice Address - Street 1:2005 ROOSEVELT RD
Practice Address - Street 2:SUITE B
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2746
Practice Address - Country:US
Practice Address - Phone:219-531-9293
Practice Address - Fax:219-531-0537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009847A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty