Provider Demographics
NPI:1245307677
Name:DAVALLE, PAMELA E (DDS)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:E
Last Name:DAVALLE
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 1:215 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4228
Mailing Address - Country:US
Mailing Address - Phone:630-573-7979
Mailing Address - Fax:
Practice Address - Street 1:2000 SPRING RD
Practice Address - Street 2:SUITE 502
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1804
Practice Address - Country:US
Practice Address - Phone:630-573-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice