Provider Demographics
NPI:1740264878
Name:STEPHEN, VALENTINE (DDS)
Entity type:Individual
Prefix:DR
First Name:VALENTINE
Middle Name:
Last Name:STEPHEN
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 1:2037 S BUCKNER BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-1824
Mailing Address - Country:US
Mailing Address - Phone:214-398-2545
Mailing Address - Fax:214-398-2017
Practice Address - Street 1:2037 S BUCKNER BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-1824
Practice Address - Country:US
Practice Address - Phone:214-398-2545
Practice Address - Fax:214-398-2017
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23615122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX26-2455983OtherFEDERAL TAX ID