Provider Demographics
NPI:1558431031
Name:VALLEY DENTAL GROUP LLC
Entity Type:Organization
Organization Name:VALLEY DENTAL GROUP LLC
Other - Org Name:VALLEY DENTAL GROUP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SALVATO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-924-8069
Mailing Address - Street 1:488 HOWE AVE
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-3114
Mailing Address - Country:US
Mailing Address - Phone:203-924-8069
Mailing Address - Fax:203-924-0828
Practice Address - Street 1:488 HOWE AVE
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-3114
Practice Address - Country:US
Practice Address - Phone:203-924-8069
Practice Address - Fax:203-924-0828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty