Provider Demographics
NPI:1447426010
Name:VALLEY VIEW DENTAL INC
Entity Type:Organization
Organization Name:VALLEY VIEW DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:R
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-934-3332
Mailing Address - Street 1:1302 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:ST PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082
Mailing Address - Country:US
Mailing Address - Phone:507-934-3332
Mailing Address - Fax:507-934-3336
Practice Address - Street 1:1302 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:ST PETER
Practice Address - State:MN
Practice Address - Zip Code:56082
Practice Address - Country:US
Practice Address - Phone:507-934-3332
Practice Address - Fax:507-934-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11490122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN886473000Medicaid
MND11490OtherMINNESOTA LICENSE NUMBER DENTAL