Provider Demographics
NPI:1639987068
Name:VALLEY DENTAL MEDICARE
Entity type:Organization
Organization Name:VALLEY DENTAL MEDICARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:509-987-2267
Mailing Address - Street 1:2334 BOCA CHICA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-2697
Mailing Address - Country:US
Mailing Address - Phone:509-987-2267
Mailing Address - Fax:956-546-1342
Practice Address - Street 1:2334 BOCA CHICA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2697
Practice Address - Country:US
Practice Address - Phone:509-987-2267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty