Manuel Antonio Valerin, DDS
Individual provider Active NPI General Practice Dentistry · Oglesby, IL
NPI 1326109596 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1326109596
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 019026530 (IL)
- Practice address
- 210 N Columbia Ave
Oglesby, IL 61348-1480 - Phone
- (815) 883-3162
- Fax
- (815) 883-7062
- NPI assigned
- Dec 12, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019026530 | IL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alliance Dental Group | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019026530 | IL | Yes |
Addresses
Primary practice location
210 N Columbia Ave
Oglesby, IL 61348-1480
Mailing address
216 Oakwood Ave.
Oglesby, IL 61348
Phone (815) 883-8147
Other providers in Oglesby, IL
- Jennifer Lynn Sowers
- St. Margaret'S Health-Peru
- St. Margaret'S Health-Peru
- St. Margaret'S Health-Peru
- St. Margaret'S Health-Peru
All providers in Oglesby, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.