Provider Demographics
NPI:1376712968
Name:WARREN VALLERAND, DDS, MD, PC
Entity Type:Organization
Organization Name:WARREN VALLERAND, DDS, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:P
Authorized Official - Last Name:VALLERAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:248-478-7200
Mailing Address - Street 1:40399 GRAND RIVER AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2148
Mailing Address - Country:US
Mailing Address - Phone:248-478-7200
Mailing Address - Fax:248-478-7237
Practice Address - Street 1:40399 GRAND RIVER AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2148
Practice Address - Country:US
Practice Address - Phone:248-478-7200
Practice Address - Fax:248-478-7237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWV0174311223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION87000Medicare PIN