Provider Demographics
NPI:1598529687
Name:VALLO RIVERVIEW, PLLC
Entity Type:Organization
Organization Name:VALLO RIVERVIEW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:VALLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-252-2273
Mailing Address - Street 1:10909 W LINEBAUGH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1741
Mailing Address - Country:US
Mailing Address - Phone:813-536-7766
Mailing Address - Fax:813-444-9858
Practice Address - Street 1:10555 BLOOMINGDALE RIDGE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578
Practice Address - Country:US
Practice Address - Phone:813-252-2273
Practice Address - Fax:813-940-5182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty