Provider Demographics
NPI:1134270655
Name:VALANTINE, MATTHEW R (DDS)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:R
Last Name:VALANTINE
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 1:10 DIAGONAL ST
Mailing Address - Street 2:STE 201
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2878
Mailing Address - Country:US
Mailing Address - Phone:435-673-7373
Mailing Address - Fax:435-656-2012
Practice Address - Street 1:10 DIAGONAL ST
Practice Address - Street 2:STE 201
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2878
Practice Address - Country:US
Practice Address - Phone:435-673-7373
Practice Address - Fax:435-656-2012
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1433901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice