Provider Demographics
NPI:1780670307
Name:VALENTINE, DWAINE EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DWAINE
Middle Name:EDWARD
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 1:460 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
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH149921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice