Provider Demographics
NPI:1861728339
Name:JOHNSON & VALENTA FAMILY DENTISTRY SC
Entity type:Organization
Organization Name:JOHNSON & VALENTA FAMILY DENTISTRY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:VALENTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:715-735-5626
Mailing Address - Street 1:PO BOX 480
Mailing Address - Street 2:1838 DUNLAP AVE
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-0480
Mailing Address - Country:US
Mailing Address - Phone:715-735-5626
Mailing Address - Fax:715-735-3283
Practice Address - Street 1:1838 DUNLAP AVE
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-1722
Practice Address - Country:US
Practice Address - Phone:715-735-5626
Practice Address - Fax:715-735-3283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2009-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty