Provider Demographics
NPI:1265009377
Name:VALLEY NEIGHBORHOOD DENTAL CENTER
Entity Type:Organization
Organization Name:VALLEY NEIGHBORHOOD DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REX
Authorized Official - Middle Name:
Authorized Official - Last Name:MALCOM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:907-602-8649
Mailing Address - Street 1:304 W EVERGREEN AVE STE 101B
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6970
Mailing Address - Country:US
Mailing Address - Phone:907-745-1966
Mailing Address - Fax:
Practice Address - Street 1:304 W EVERGREEN AVE STE 101B
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6970
Practice Address - Country:US
Practice Address - Phone:907-745-1966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental