Provider Demographics
NPI:1740479120
Name:VALLE, JOSEPH SALVADOR (DDS)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:SALVADOR
Last Name:VALLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 WATER ST
Mailing Address - Street 2:SUITE K-1
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4124
Mailing Address - Country:US
Mailing Address - Phone:831-423-2400
Mailing Address - Fax:831-423-6871
Practice Address - Street 1:550 WATER ST
Practice Address - Street 2:SUITE K-1
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4124
Practice Address - Country:US
Practice Address - Phone:831-423-2400
Practice Address - Fax:831-423-6871
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52950122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist