Healthcare Provider Details

I. General information

NPI: 1912443029
Provider Name (Legal Business Name): ALAN J VALLARINE DDS INC 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 FRESNO ST SUITE 100
FRESNO CA
93721-1327
US

IV. Provider business mailing address

2828 FRESNO ST SUITE 100
FRESNO CA
93721-1327
US

V. Phone/Fax

Practice location:
  • Phone: 559-263-9648
  • Fax:
Mailing address:
  • Phone: 559-263-9648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ALAN J VALLARINE
Title or Position: PRESIDENT
Credential: DDS
Phone: 219-345-2486