Individual
MICHAEL VALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
040406
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000491895001
BLUE SHIELD NENY
—
Enumeration date
10/17/2005
Last updated
04/09/2009
Update your record
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