Provider Demographics
NPI:1013082833
Name:VALENTINE, ALLAN DARRELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:DARRELL
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 1:3111 WALL ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-9008
Mailing Address - Country:US
Mailing Address - Phone:859-223-1833
Mailing Address - Fax:859-873-2218
Practice Address - Street 1:3111 WALL ST STE 2
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-9008
Practice Address - Country:US
Practice Address - Phone:859-223-1833
Practice Address - Fax:859-873-2218
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28411223G0001X
KY45371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3203732Medicaid