Brenda M Valliere, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

12008807 Issued in IN

Practice address

1330 E State Blvd
Fort Wayne, IN 46805-4422

Phone

(260) 484-5614

Fax

(260) 484-5614

NPI assigned

Oct 22, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Summit City Smiles

  • Dental Clinic/Center
  • Fort Wayne, IN
  • NPI 1083080386
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1256169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256169600000",
    "number": "1154657450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1330 E STATE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468054422",
            "telephone_number": "260-484-5614",
            "fax_number": "260-484-5614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 E STATE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468054422",
            "telephone_number": "260-484-5614",
            "fax_number": "260-484-5614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALLIERE",
        "first_name": "BRENDA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-22",
        "last_updated": "2009-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12008807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LEGACY PROVIDER IDENTIFICATION NUMBER",
            "identifier": "200855410",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIANA DENTAL LICENSE NUMBER",
            "identifier": "12008807",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mekenzie L Vachon, RBT
• Michael S Valade, M.D.
• Maria Regina Valcarcel, MD
• Kathryn Valentic
• Valerie E Lake, DDS, LLC
• Jeffrey Paul Valliere, DDS
• Roger Paul Valliere, D.D.S.
• Adele Vallow
• Victoria A. Vamos, PA-C
• Matthew Van Curen

• Dentist in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.