Provider Demographics
NPI:1740578277
Name:VALENTINE DENTAL CLINIC
Entity Type:Organization
Organization Name:VALENTINE DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BATTERSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-376-3390
Mailing Address - Street 1:331 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:VALENTINE
Mailing Address - State:NE
Mailing Address - Zip Code:69201-1880
Mailing Address - Country:US
Mailing Address - Phone:402-376-3390
Mailing Address - Fax:402-376-2005
Practice Address - Street 1:331 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:VALENTINE
Practice Address - State:NE
Practice Address - Zip Code:69201-1880
Practice Address - Country:US
Practice Address - Phone:402-376-3390
Practice Address - Fax:402-376-2005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4566122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty