Individual
DR. BRENDA M VALLIERE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1330 E STATE BLVD, FORT WAYNE, IN 46805-4422
(260) 484-5614
(260) 484-5614
Mailing address
1330 E STATE BLVD, FORT WAYNE, IN 46805-4422
(260) 484-5614
(260) 484-5614
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12008807
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12008807
INDIANA DENTAL LICENSE NUMBER
IN
01
—
200855410
LEGACY PROVIDER IDENTIFICATION NUMBER
IN
Enumeration date
10/22/2009
Last updated
10/22/2009
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