Jeffrey Paul Valliere, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

12012713A Issued in IN

Practice address

1330 E State Blvd
Fort Wayne, IN 46805-4422

Phone

(260) 484-5614

NPI assigned

Jun 13, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

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

{
    "created_epoch": "1497312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642550400000",
    "number": "1528598638",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALLIERE",
        "first_name": "JEFFREY",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-06-13",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12012713A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael S Valade, M.D.
• Maria Regina Valcarcel, MD
• Kathryn Valentic
• Valerie E Lake, DDS, LLC
• Brenda M Valliere, DDS
• Roger Paul Valliere, D.D.S.
• Adele Vallow
• Victoria A. Vamos, PA-C
• Matthew Van Curen
• Marissa Rose Van de Weg

• 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 Jan 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.