Active NPI
Michael Valla, DDS
- Dentist
- Glens Falls, NY
National Provider Identifier
1629067384
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 040406
- Practice address
- 100 Park St
Glens Falls, NY 12801-4413 - Phone
- (518) 926-5908
- Fax
- (518) 926-5909
- NPI assigned
- Oct 17, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 040406 | NY | Primary |
Addresses
Primary practice location
100 Park St
Glens Falls, NY 12801-4413
Mailing address
PO Box 304
Glens Falls, NY 12801-0304
Phone (518) 926-6992
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000491895001 | Other | BLUE SHIELD NENY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 040406 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239235200000",
"number": "1629067384",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 304",
"city": "GLENS FALLS",
"state": "NY",
"postal_code": "128010304",
"telephone_number": "518-926-6992",
"fax_number": "518-926-6983"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 PARK ST",
"city": "GLENS FALLS",
"state": "NY",
"postal_code": "128014413",
"telephone_number": "518-926-5908",
"fax_number": "518-926-5909"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VALLA",
"first_name": "MICHAEL",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-17",
"last_updated": "2009-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "040406",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD NENY",
"identifier": "000491895001",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Glens Falls, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.