Provider Demographics
NPI:1962508770
Name:VALLEY DENTAL GROUP INC
Entity Type:Organization
Organization Name:VALLEY DENTAL GROUP INC
Other - Org Name:PROFESSIONAL BUSINESS NAME
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT VDG INC
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KIMBERLY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-867-8354
Mailing Address - Street 1:1852 MERRIMAN ROAD
Mailing Address - Street 2:VALLEY DENTAL GROUP INC
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313
Mailing Address - Country:US
Mailing Address - Phone:330-867-8354
Mailing Address - Fax:330-867-6960
Practice Address - Street 1:1852 MERRIMAN ROAD
Practice Address - Street 2:VALLEY DENTAL GROUP INC
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313
Practice Address - Country:US
Practice Address - Phone:330-867-8354
Practice Address - Fax:330-867-6960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty