Provider Demographics
NPI:1770083172
Name:VALLEY DENTURE CARE LLC
Entity type:Organization
Organization Name:VALLEY DENTURE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-899-9516
Mailing Address - Street 1:PO BOX 505
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530-0505
Mailing Address - Country:US
Mailing Address - Phone:541-899-9516
Mailing Address - Fax:
Practice Address - Street 1:535 N 5TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97530-9704
Practice Address - Country:US
Practice Address - Phone:541-899-9516
Practice Address - Fax:541-899-9516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122400000XDental ProvidersDenturistGroup - Single Specialty