Provider Demographics
NPI:1265698252
Name:VALENTINE, KYLE B (DMD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:B
Last Name:VALENTINE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21435 MILES DR
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-2880
Mailing Address - Country:US
Mailing Address - Phone:503-367-7617
Mailing Address - Fax:
Practice Address - Street 1:10000 SE MAIN ST
Practice Address - Street 2:SUITE 20
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2448
Practice Address - Country:US
Practice Address - Phone:503-254-5593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9146122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist