Provider Demographics
NPI:1790732824
Name:VALLEY DENTAL CARE PC
Entity Type:Organization
Organization Name:VALLEY DENTAL CARE PC
Other - Org Name:VALLEY DENTAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:VARDA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-897-2483
Mailing Address - Street 1:1300 N MCCLINTOCK DR
Mailing Address - Street 2:SUITE E12
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-7205
Mailing Address - Country:US
Mailing Address - Phone:480-897-2483
Mailing Address - Fax:480-820-1218
Practice Address - Street 1:1300 N MCCLINTOCK DR
Practice Address - Street 2:SUITE E12
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-7205
Practice Address - Country:US
Practice Address - Phone:480-897-2483
Practice Address - Fax:480-820-1218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ859936OtherUNITED CONCORDIA
AZAZ0485310OtherBLUE CROSS BLUE SHIELD AZ