Provider Demographics
NPI:1790909034
Name:VALLONE, DOMINIC RICARDO (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:RICARDO
Last Name:VALLONE
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 JUNCTION DR STE C
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6512
Mailing Address - Country:US
Mailing Address - Phone:956-727-1212
Mailing Address - Fax:
Practice Address - Street 1:1310 JUNCTION DR STE C
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6512
Practice Address - Country:US
Practice Address - Phone:956-727-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX158791223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics