Provider Demographics
NPI:1639243975
Name:VALENTINE, LISA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WINDY MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4346
Mailing Address - Country:US
Mailing Address - Phone:410-852-0928
Mailing Address - Fax:
Practice Address - Street 1:6700 ALEXANDER BELL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2122
Practice Address - Country:US
Practice Address - Phone:888-964-6681
Practice Address - Fax:888-662-0859
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2022-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD123651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
006960357OtherADA
MD010878200Medicaid
12189777OtherCAQH