Organization
MICHELLE BENTO LAVALL, DMD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY SYDE (MANAGER)
(508) 679-2906
Entity
Organization
Contact information
Practice address
164 WALNUT ST, FALL RIVER, MA 02720-2418
(508) 679-2906
Mailing address
164 WALNUT ST, FALL RIVER, MA 02720-2418
(508) 679-2906
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
19261
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11711
BLUE CROSS
MA
01
—
8517-3
BLUE CROSS OF RI
RI
Enumeration date
04/15/2008
Last updated
04/15/2008
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