Provider Demographics
NPI:1356401194
Name:LAPOLLA, VALERIE NICOLE (DDS)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:NICOLE
Last Name:LAPOLLA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:VINCENT
Other - Middle Name:NICHOLAS
Other - Last Name:LAPOLLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:RR 5 BOX 446
Mailing Address - Street 2:SANTA CLARA HEALTH CENTER
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-8908
Mailing Address - Country:US
Mailing Address - Phone:505-753-9421
Mailing Address - Fax:505-753-5039
Practice Address - Street 1:RR 5 BOX 446
Practice Address - Street 2:SANTA CLARA HEALTH CENTER
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-8908
Practice Address - Country:US
Practice Address - Phone:505-753-9421
Practice Address - Fax:505-753-5039
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH204791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM28475054Medicaid