Provider Demographics
NPI:1225152770
Name:VALLERA, JOHN JOSEPH (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:VALLERA
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 1:200 STANTON BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-3700
Mailing Address - Country:US
Mailing Address - Phone:740-264-5945
Mailing Address - Fax:740-264-6257
Practice Address - Street 1:200 STANTON BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-3700
Practice Address - Country:US
Practice Address - Phone:740-264-5945
Practice Address - Fax:740-264-6257
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17698122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist