Provider Demographics
NPI:1386692093
Name:VALLEY, MAUREEN A (DMD)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:A
Last Name:VALLEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2400 LAS GALLINAS AVE
Mailing Address - Street 2:SUITE #130
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1447
Mailing Address - Country:US
Mailing Address - Phone:415-479-2400
Mailing Address - Fax:415-901-2628
Practice Address - Street 1:126 LUCAS PARK DR
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1717
Practice Address - Country:US
Practice Address - Phone:415-479-2400
Practice Address - Fax:415-901-2628
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA467061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics