Individual
DR. GREGORY MICHAEL VALLECORSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
4 SUNSET DR, LATHAM, NY 12110-2104
(518) 785-5100
Mailing address
24 CAVALIER WAY, LATHAM, NY 12110-1998
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
057400-1
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/02/2013
Last updated
08/11/2014
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