Provider Demographics
NPI:1174855845
Name:VALINDA DENTAL OFFICE
Entity Type:Organization
Organization Name:VALINDA DENTAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-918-8889
Mailing Address - Street 1:1447 N. VALINDA AV.
Mailing Address - Street 2:STE. F
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91774
Mailing Address - Country:US
Mailing Address - Phone:626-918-8889
Mailing Address - Fax:626-919-6159
Practice Address - Street 1:1447 N. VALINDA AV.
Practice Address - Street 2:STE. F
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91774
Practice Address - Country:US
Practice Address - Phone:626-918-8889
Practice Address - Fax:626-919-6159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA417806OtherDELTA DENTAL
CA1325178OtherCONCORDIA