Provider Demographics
NPI:1417647678
Name:VALUDENTAL ST JOSEPH LLC
Entity Type:Organization
Organization Name:VALUDENTAL ST JOSEPH LLC
Other - Org Name:CELEBRATE DENTAL & BRACES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-208-0000
Mailing Address - Street 1:4015 FREDERICK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4015 FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3156
Practice Address - Country:US
Practice Address - Phone:816-208-0000
Practice Address - Fax:816-654-6766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-11
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental