Provider Demographics
NPI:1154040830
Name:SPRING VALLEY DENTAL ASSOCIATES LLC
Entity type:Organization
Organization Name:SPRING VALLEY DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIFRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-578-5027
Mailing Address - Street 1:1922 EDWARDSVILLE CLUB PLAZA CT
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-3717
Mailing Address - Country:US
Mailing Address - Phone:888-502-7339
Mailing Address - Fax:
Practice Address - Street 1:904 E HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-2868
Practice Address - Country:US
Practice Address - Phone:186-632-8471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty