Provider Demographics
NPI:1851930416
Name:WATER VALLEY DENTAL PLLC
Entity Type:Organization
Organization Name:WATER VALLEY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-402-1744
Mailing Address - Street 1:3641 WATTS ST
Mailing Address - Street 2:
Mailing Address - City:TIMNATH
Mailing Address - State:CO
Mailing Address - Zip Code:80547-2281
Mailing Address - Country:US
Mailing Address - Phone:970-402-1744
Mailing Address - Fax:
Practice Address - Street 1:1349 WATER VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-6263
Practice Address - Country:US
Practice Address - Phone:303-558-6606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental