Provider Demographics
NPI:1306915475
Name:VALKENAAR, JOHN JACOB (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JACOB
Last Name:VALKENAAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10740 RESEARCH BLVD
Mailing Address - Street 2:STE. 125
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5797
Mailing Address - Country:US
Mailing Address - Phone:512-795-9960
Mailing Address - Fax:512-795-9508
Practice Address - Street 1:10740 RESEARCH BLVD
Practice Address - Street 2:STE. 125
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5797
Practice Address - Country:US
Practice Address - Phone:512-795-9960
Practice Address - Fax:512-795-9508
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice