Provider Demographics
NPI:1639296585
Name:VALENTINE, MICHAEL TODD (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TODD
Last Name:VALENTINE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-2936
Mailing Address - Country:US
Mailing Address - Phone:734-241-1144
Mailing Address - Fax:734-241-6455
Practice Address - Street 1:759 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-2936
Practice Address - Country:US
Practice Address - Phone:734-241-1144
Practice Address - Fax:734-241-6455
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010174581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice