Provider Demographics
NPI:1407464928
Name:VALLI DENTAL CORPORATION
Entity Type:Organization
Organization Name:VALLI DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:VALLI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-689-2102
Mailing Address - Street 1:292 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450-1236
Mailing Address - Country:US
Mailing Address - Phone:978-448-5241
Mailing Address - Fax:
Practice Address - Street 1:292 MAIN ST
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-1236
Practice Address - Country:US
Practice Address - Phone:724-689-2102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental