Individual
DR. SAMUEL JOSEPH LAVALLEY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1520 10TH ST, MENOMINEE, MI 49858-2954
(906) 863-8522
Mailing address
1520 10TH ST, MENOMINEE, MI 49858-2954
(906) 863-8522
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901012364
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33427000
—
WI
Enumeration date
07/31/2006
Last updated
07/09/2007
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