Provider Demographics
NPI:1396844734
Name:VALENTINE, BRETT A (DMD)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:A
Last Name:VALENTINE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 469
Mailing Address - Street 2:
Mailing Address - City:SUMRALL
Mailing Address - State:MS
Mailing Address - Zip Code:39482
Mailing Address - Country:US
Mailing Address - Phone:601-758-0150
Mailing Address - Fax:601-758-0149
Practice Address - Street 1:4864 B HWY 589
Practice Address - Street 2:
Practice Address - City:SUMRALL
Practice Address - State:MS
Practice Address - Zip Code:39482
Practice Address - Country:US
Practice Address - Phone:601-758-0150
Practice Address - Fax:601-758-0149
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2752 931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660280Medicaid
873476OtherUNITED CONCORDIA