Provider Demographics
NPI:1417427493
Name:VALLEY DENTAL, INC
Entity Type:Organization
Organization Name:VALLEY DENTAL, INC
Other - Org Name:MINT CONDITION DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-397-2951
Mailing Address - Street 1:PO BOX 19187
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99219
Mailing Address - Country:US
Mailing Address - Phone:509-235-2900
Mailing Address - Fax:509-235-2925
Practice Address - Street 1:204 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:WA
Practice Address - Zip Code:99111-1820
Practice Address - Country:US
Practice Address - Phone:509-397-2951
Practice Address - Fax:509-397-6772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty