Provider Demographics
NPI:1447493457
Name:OAK VALLEY MEDICAL & DENTAL, PC
Entity type:Organization
Organization Name:OAK VALLEY MEDICAL & DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:845-658-7763
Mailing Address - Street 1:100 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15437-1390
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:103 NEW MEADOW RUN DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:PA
Practice Address - Zip Code:15437-1391
Practice Address - Country:US
Practice Address - Phone:724-749-1517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty