Provider Demographics
NPI:1598791162
Name:VALESH, KEITH JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:JAMES
Last Name:VALESH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 EAST CHARLES
Mailing Address - Street 2:
Mailing Address - City:OELWEIN
Mailing Address - State:IA
Mailing Address - Zip Code:50662-1940
Mailing Address - Country:US
Mailing Address - Phone:319-283-4981
Mailing Address - Fax:319-283-4780
Practice Address - Street 1:216 EAST CHARLES
Practice Address - Street 2:
Practice Address - City:OELWEIN
Practice Address - State:IA
Practice Address - Zip Code:50662-1940
Practice Address - Country:US
Practice Address - Phone:319-283-4981
Practice Address - Fax:319-283-4780
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA54121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice