Provider Demographics
NPI:1417101601
Name:VALLEY OAKS DENTAL
Entity Type:Organization
Organization Name:VALLEY OAKS DENTAL
Other - Org Name:STEINER & VENTRUCCI
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WICHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-432-8110
Mailing Address - Street 1:7373 147TH ST. W. #116
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124
Mailing Address - Country:US
Mailing Address - Phone:952-432-8110
Mailing Address - Fax:952-432-4457
Practice Address - Street 1:7373 147TH ST. W. #116
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124
Practice Address - Country:US
Practice Address - Phone:952-432-8110
Practice Address - Fax:952-432-4457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12069122300000X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty