Provider Demographics
NPI:1205099454
Name:VALENTINAS, MARK VICTOR (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:VICTOR
Last Name:VALENTINAS
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 1:1001 E CHICAGO AVE
Mailing Address - Street 2:#143
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5526
Mailing Address - Country:US
Mailing Address - Phone:630-369-0111
Mailing Address - Fax:630-369-0378
Practice Address - Street 1:1001 E CHICAGO AVE
Practice Address - Street 2:#143
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5526
Practice Address - Country:US
Practice Address - Phone:630-369-0111
Practice Address - Fax:630-369-0378
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190178981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice