Provider Demographics
NPI:1366957953
Name:JESSIE V. VALLEE, DDS INC.
Entity type:Organization
Organization Name:JESSIE V. VALLEE, DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:VALLEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-325-7711
Mailing Address - Street 1:1300 UNIVERSITY DR STE 5
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4254
Mailing Address - Country:US
Mailing Address - Phone:650-325-7711
Mailing Address - Fax:650-325-7715
Practice Address - Street 1:1300 UNIVERSITY DR STE 5
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4254
Practice Address - Country:US
Practice Address - Phone:650-325-7711
Practice Address - Fax:650-325-7715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA529511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty