Provider Demographics
NPI:1427154004
Name:VALLECORSA, DAVID J (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:VALLECORSA
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 1:4 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2104
Mailing Address - Country:US
Mailing Address - Phone:518-785-5100
Mailing Address - Fax:518-785-5171
Practice Address - Street 1:4 SUNSET DR
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2104
Practice Address - Country:US
Practice Address - Phone:518-785-5100
Practice Address - Fax:518-785-5171
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0350921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY035095OtherSTATE LICENCE NUMBER