| Valley Dental Group | |
|
7501 Golden Valley Rd Golden Valley MN 55427-4563 | |
| (763) 544-2213 | |
| Not Available |
| Full Name | Valley Dental Group |
|---|---|
| Speciality | Clinic/Center |
| Location | 7501 Golden Valley Rd, Golden Valley, Minnesota |
| Authorized Official Name and Position | Tammy Lewis (PAYER ENROLLMENT SUPERVISOR) |
| Authorized Official Contact | 7812133336 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Valley Dental Group 7501 Golden Valley Rd Golden Valley MN 55427-4563 Ph: () - | Valley Dental Group 7501 Golden Valley Rd Golden Valley MN 55427-4563 Ph: (763) 544-2213 |
| NPI Number | 1649353921 |
|---|---|
| Provider Enumeration Date | 10/23/2006 |
| Last Update Date | 02/18/2021 |
| Medicare PECOS PAC ID | 8022422856 |
|---|---|
| Medicare Enrollment ID | O20210205001635 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649353921 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Brian T Evensen |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1982658746 PECOS PAC ID: 8628358371 Enrollment ID: I20210303000909 |
| Provider Name | John D Gerstner |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1205903713 PECOS PAC ID: 3577839331 Enrollment ID: I20210316001140 |
| Provider Name | Brian D Jordan |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1609943109 PECOS PAC ID: 5991085649 Enrollment ID: I20210317001938 |
| Provider Name | Andrew M Liu |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1528123064 PECOS PAC ID: 2860768124 Enrollment ID: I20210318001680 |
| Provider Name | Janet G Parsons |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1912082223 PECOS PAC ID: 6608142955 Enrollment ID: I20210324002559 |
| Provider Name | Sandra S Fenske |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1346317831 PECOS PAC ID: 4587930359 Enrollment ID: I20210324002563 |
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