Provider Demographics
NPI:1790991008
Name:VALLERA, JOANN LOIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOANN
Middle Name:LOIS
Last Name:VALLERA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 WEST RD
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-3730
Mailing Address - Country:US
Mailing Address - Phone:860-872-2454
Mailing Address - Fax:860-870-1385
Practice Address - Street 1:175 WEST RD
Practice Address - Street 2:
Practice Address - City:ELLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06029-3730
Practice Address - Country:US
Practice Address - Phone:860-872-2454
Practice Address - Fax:860-870-1385
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT0078691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice