Provider Demographics
NPI:1679618201
Name:VALERIE H. WASHINGTON, DDS, A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:VALERIE H. WASHINGTON, DDS, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:WASHINTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-641-1157
Mailing Address - Street 1:3200 MONROE HWY
Mailing Address - Street 2:SUITE 134
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-8110
Mailing Address - Country:US
Mailing Address - Phone:318-641-1157
Mailing Address - Fax:
Practice Address - Street 1:3200 MONROE HWY
Practice Address - Street 2:SUITE 134
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-8110
Practice Address - Country:US
Practice Address - Phone:318-641-1157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4337122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty