Provider Demographics
NPI:1144744541
Name:JUDSON D VALSTAD DMD INC
Entity Type:Organization
Organization Name:JUDSON D VALSTAD DMD INC
Other - Org Name:VALSTAD DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDSON
Authorized Official - Middle Name:
Authorized Official - Last Name:VALSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:970-686-7121
Mailing Address - Street 1:1292 MAIN ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-5965
Mailing Address - Country:US
Mailing Address - Phone:970-686-7121
Mailing Address - Fax:970-686-1021
Practice Address - Street 1:1292 MAIN ST UNIT 2
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-5965
Practice Address - Country:US
Practice Address - Phone:970-686-7121
Practice Address - Fax:970-686-1021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO79061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty