Provider Demographics
NPI:1003826538
Name:MINOR, VALERIE J V (DMS, MS)
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:J V
Last Name:MINOR
Suffix:
Gender:F
Credentials:DMS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 IBIS CT
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-4544
Mailing Address - Country:US
Mailing Address - Phone:904-583-9981
Mailing Address - Fax:
Practice Address - Street 1:2363 DUNN AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4601
Practice Address - Country:US
Practice Address - Phone:904-751-6030
Practice Address - Fax:904-751-5828
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN164001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics