Provider Demographics
NPI:1326243114
Name:VAILLANT DENTAL SERVICES, LLC
Entity Type:Organization
Organization Name:VAILLANT DENTAL SERVICES, LLC
Other - Org Name:VAILLANT FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:VAILLANT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-388-6709
Mailing Address - Street 1:421 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-2555
Mailing Address - Country:US
Mailing Address - Phone:651-388-6709
Mailing Address - Fax:651-388-3187
Practice Address - Street 1:421 W 4TH ST
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-2555
Practice Address - Country:US
Practice Address - Phone:651-388-6709
Practice Address - Fax:651-388-3187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN70241223G0001X
MN115241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty