Provider Demographics
NPI:1013020601
Name:WALLEY, ROBERT M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:WALLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 POST ST
Mailing Address - Street 2:SUITE 1205
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-1303
Mailing Address - Country:US
Mailing Address - Phone:415-956-5690
Mailing Address - Fax:415-421-6260
Practice Address - Street 1:490 POST ST
Practice Address - Street 2:SUITE 1205
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-1303
Practice Address - Country:US
Practice Address - Phone:415-956-5690
Practice Address - Fax:415-421-6260
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20958122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist