Provider Demographics
NPI:1982709572
Name:VALLARINE DENTAL CORPORATION
Entity Type:Organization
Organization Name:VALLARINE DENTAL CORPORATION
Other - Org Name:FRESNO DENTAL SURGERY CENTER, A VALLARINE DENTAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:VALLARINE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-345-2486
Mailing Address - Street 1:2828 FRESNO ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1327
Mailing Address - Country:US
Mailing Address - Phone:559-263-9648
Mailing Address - Fax:559-263-9777
Practice Address - Street 1:2828 FRESNO ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1327
Practice Address - Country:US
Practice Address - Phone:559-263-9648
Practice Address - Fax:559-263-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000219261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9862301OtherHEALTHY FAMILIES
CAAS1770OtherBLUE CROSS
CASURO1770FMedicaid
CA05C001770OtherCMS
CAG9397701Medicaid
CAZZZ019572Medicaid