Provider Demographics
NPI:1437294501
Name:VALLEY DENTAL CENTER, LLC
Entity Type:Organization
Organization Name:VALLEY DENTAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:FINN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-651-3541
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:240 FARMS VILLAGE RD
Mailing Address - City:WEST SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06092-0266
Mailing Address - Country:US
Mailing Address - Phone:860-651-3541
Mailing Address - Fax:
Practice Address - Street 1:240 FARMS VILLAGE RD
Practice Address - Street 2:
Practice Address - City:WEST SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06092-0266
Practice Address - Country:US
Practice Address - Phone:860-651-3541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT43081223G0001X
CT59571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty