Provider Demographics
NPI:1760997803
Name:VALLEY ENDODONTICS
Entity Type:Organization
Organization Name:VALLEY ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-768-0419
Mailing Address - Street 1:2350 NW CENTURY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3495
Mailing Address - Country:US
Mailing Address - Phone:541-768-0419
Mailing Address - Fax:541-768-0521
Practice Address - Street 1:2350 NW CENTURY DR STE 200
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3495
Practice Address - Country:US
Practice Address - Phone:541-768-0419
Practice Address - Fax:541-768-0521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty