Provider Demographics
NPI:1043433618
Name:VALLAR, MAGDALENA PIDLAOAN (DMD MPH)
Entity Type:Individual
Prefix:DR
First Name:MAGDALENA
Middle Name:PIDLAOAN
Last Name:VALLAR
Suffix:
Gender:F
Credentials:DMD MPH
Other - Prefix:
Other - First Name:MAGDALENA
Other - Middle Name:AVELINO
Other - Last Name:PIDLAOAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD MPH
Mailing Address - Street 1:3 JILL COURT
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136
Mailing Address - Country:US
Mailing Address - Phone:410-833-5920
Mailing Address - Fax:
Practice Address - Street 1:2507 ST PAUL STREET
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218
Practice Address - Country:US
Practice Address - Phone:410-243-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDENTIST05522122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD05121OtherMD BLUE CROSS BLUE SHIELD