Provider Demographics
NPI:1447340039
Name:WASHINGTON, VALERIE H (DDS)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:H
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 MONROE HWY
Mailing Address - Street 2:STE 134 KINGS COUNTRY VILLAGE
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-4200
Mailing Address - Country:US
Mailing Address - Phone:318-641-1157
Mailing Address - Fax:318-641-9919
Practice Address - Street 1:3200 MONROE HWY
Practice Address - Street 2:STE 134 KINGS COUNTRY VILLAGE
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4200
Practice Address - Country:US
Practice Address - Phone:318-641-1157
Practice Address - Fax:318-641-9919
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA43371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1843377Medicaid