Provider Demographics
NPI:1558984021
Name:VALLEY FAMILY DENTAL GROUP
Entity Type:Organization
Organization Name:VALLEY FAMILY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PULASKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-414-0001
Mailing Address - Street 1:10800 PARAMOUNT BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3324
Mailing Address - Country:US
Mailing Address - Phone:562-414-0001
Mailing Address - Fax:
Practice Address - Street 1:10800 PARAMOUNT BLVD STE 305
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-3324
Practice Address - Country:US
Practice Address - Phone:562-414-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental