Provider Demographics
NPI:1932362589
Name:VALLEY DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:VALLEY DENTAL ASSOCIATES
Other - Org Name:VALLEY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-665-2275
Mailing Address - Street 1:219 S 2ND ST
Mailing Address - Street 2:VALLEY DENTAL CARE
Mailing Address - City:LESUEUR
Mailing Address - State:MN
Mailing Address - Zip Code:56058-1903
Mailing Address - Country:US
Mailing Address - Phone:507-665-2275
Mailing Address - Fax:507-665-6842
Practice Address - Street 1:219 S 2ND ST
Practice Address - Street 2:VALLEY DENTAL CARE
Practice Address - City:LESUEUR
Practice Address - State:MN
Practice Address - Zip Code:56058-1903
Practice Address - Country:US
Practice Address - Phone:507-665-2275
Practice Address - Fax:507-665-6842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2145164Medicare UPIN