Individual
JESSICA J. LAVALLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
11437 OLIVE BLVD, CREVE COEUR, MO 63141-7108
(314) 355-2000
Mailing address
5300 W MAIN ST, BELLEVILLE, IL 62226-4733
(618) 234-2908
(618) 234-3278
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019028092
IL
1223G0001X
General Practice Dentistry
Primary
2011014087
MO
Other
Enumeration date
07/24/2009
Last updated
07/21/2022
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