Provider Demographics
NPI:1497873210
Name:VALESTRAND, CHRISTINE ELISE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:ELISE
Last Name:VALESTRAND
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S JERSEY AVE
Mailing Address - Street 2:SUITE 29
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2034
Mailing Address - Country:US
Mailing Address - Phone:631-689-5555
Mailing Address - Fax:631-689-1503
Practice Address - Street 1:100 S JERSEY AVE
Practice Address - Street 2:SUITE 29
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2034
Practice Address - Country:US
Practice Address - Phone:631-689-5555
Practice Address - Fax:631-689-1503
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0452941223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics