Provider Demographics
NPI:1760509798
Name:DWAINE E. VALENTINE, D.D.S., INC.
Entity Type:Organization
Organization Name:DWAINE E. VALENTINE, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DWAINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:D,D,S,
Authorized Official - Phone:937-833-4411
Mailing Address - Street 1:460 RONA PKWY
Mailing Address - Street 2:P.O. BOX 159
Mailing Address - City:BROOKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45309-1118
Mailing Address - Country:US
Mailing Address - Phone:937-833-4411
Mailing Address - Fax:937-833-2473
Practice Address - Street 1:460 RONA PKWY
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:OH
Practice Address - Zip Code:45309-1118
Practice Address - Country:US
Practice Address - Phone:937-833-4411
Practice Address - Fax:937-833-2473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14992122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty