Provider Demographics
NPI:1366585010
Name:VALLE, RODOLFO (DDS)
Entity type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:
Last Name:VALLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:RUDY
Other - Middle Name:
Other - Last Name:VALLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:925 WEST JEFFERSON STREET
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-6337
Mailing Address - Country:US
Mailing Address - Phone:956-542-4135
Mailing Address - Fax:956-542-1150
Practice Address - Street 1:925 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-6337
Practice Address - Country:US
Practice Address - Phone:956-542-4135
Practice Address - Fax:956-542-1150
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6945122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist