Provider Demographics
NPI:1851798581
Name:VALLEY PEDIATRIC DENTAL
Entity Type:Organization
Organization Name:VALLEY PEDIATRIC DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-963-9601
Mailing Address - Street 1:350 FALCON RIDGE PKWY
Mailing Address - Street 2:BUILDING #200 STE#101
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89027-8878
Mailing Address - Country:US
Mailing Address - Phone:888-963-9601
Mailing Address - Fax:888-963-9601
Practice Address - Street 1:350 FALCON RIDGE PKWY
Practice Address - Street 2:BUILDING #200 STE#101
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-8878
Practice Address - Country:US
Practice Address - Phone:888-963-9601
Practice Address - Fax:888-963-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS6971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty