Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Ambulatory Surgical |
261QA1903X | 49 | Ambulatory Surgical Center | |
Anesthesiology |
207L00000X | 79 | Physician/Addiction Medicine | |
Dentist Anesthesiologist |
1223D0004X | |||
Endodontics |
1223E0200X | |||
Medical |
363AM0700X | 97 | Physician Assistant | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery | |
Oral and Maxillofacial Pathology |
1223P0106X | |||
Oral and Maxillofacial Radiology |
1223X0008X | |||
Oral and Maxillofacial Surgery |
1223S0112X | 19 | Oral Surgery (Dentist only) | |
Pediatric Dentistry |
1223P0221X | |||
Pediatrics |
163WP0200X | |||
Periodontics |
1223P0300X | |||
Trauma Surgery |
2086S0127X | 02 | Physician/General Surgery |
| NPI # | 1194230573 |
| LBN Legal business name | VALLEYGATE DENTAL SURGERY CENTERS OF THE WEST, LLC |
| Authorized official | VIRGINIA JONES - (CHIEF EXECUTIVE OFFICER) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 12/07/2017 |
| Last updated | 03/12/2024 - About 2 years ago |
| Identifiers | n/a |
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