MEDICARE: DR. PAMELA E DAVALLE D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1245307677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA E DAVALLE D.D.S.

Provider Business Mailing Address
First Line	:	215 E 1ST ST
Second Line	:
City	:	HINSDALE
State	:	IL
Zip	:	60521-4228
Country	:	US
Telephone Number	:	630-573-7979
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 SPRING RD
Second Line	:	SUITE 502
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1804
Country	:	US
Telephone Number	:	630-573-7979
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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