Provider Demographics
NPI:1295852002
Name:DAVID, VALERIE A (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:A
Last Name:DAVID
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 CHANDLER ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-3300
Mailing Address - Country:US
Mailing Address - Phone:508-754-5226
Mailing Address - Fax:508-754-5228
Practice Address - Street 1:372 CHANDLER ST
Practice Address - Street 2:SUITE 10
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-3300
Practice Address - Country:US
Practice Address - Phone:508-754-5226
Practice Address - Fax:508-754-5228
Is Sole Proprietor?:No
Enumeration Date:2007-03-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0204421Medicaid