Provider Demographics
NPI:1609022789
Name:VALENTINE, LESLIE R (RDH,NTP)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:R
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:RDH,NTP
Other - Prefix:MRS
Other - First Name:NADINE
Other - Middle Name:
Other - Last Name:BAYBARZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:3144 107TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98512-9105
Mailing Address - Country:US
Mailing Address - Phone:360-943-5203
Mailing Address - Fax:
Practice Address - Street 1:3144 107TH AVE SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98512-9105
Practice Address - Country:US
Practice Address - Phone:360-943-5203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00001967124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist