Provider Demographics
NPI:1982397519
Name:VALLEY, GABRIEL PATRICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:PATRICK
Last Name:VALLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 MANN HILL RD
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04429-7211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:168 W BROADWAY
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-4003
Practice Address - Country:US
Practice Address - Phone:207-794-6577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN50411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice