Provider Demographics
NPI:1427773506
Name:LAVALLEY, DENNIS G SR
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:G
Last Name:LAVALLEY
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 BRIGHAM ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2102
Mailing Address - Country:US
Mailing Address - Phone:419-787-0296
Mailing Address - Fax:
Practice Address - Street 1:3220 BRIGHAM ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2102
Practice Address - Country:US
Practice Address - Phone:419-787-0296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care