Provider Demographics
NPI:1396950697
Name:VALLETTE, FOLGER BRYANT III (DDS)
Entity type:Individual
Prefix:
First Name:FOLGER
Middle Name:BRYANT
Last Name:VALLETTE
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-4026
Mailing Address - Country:US
Mailing Address - Phone:806-655-2191
Mailing Address - Fax:806-655-2192
Practice Address - Street 1:2000 4TH AVE
Practice Address - Street 2:
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015-4026
Practice Address - Country:US
Practice Address - Phone:806-655-2191
Practice Address - Fax:806-655-2192
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13230122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist