Provider Demographics
NPI:1831274638
Name:VALENTINE, DOUGLAS JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JAMES
Last Name:VALENTINE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:300 SIERRA COLLEGE DR
Mailing Address - Street 2:#120
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5082
Mailing Address - Country:US
Mailing Address - Phone:530-274-4470
Mailing Address - Fax:530-274-4472
Practice Address - Street 1:300 SIERRA COLLEGE DR
Practice Address - Street 2:#120
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5082
Practice Address - Country:US
Practice Address - Phone:530-274-4470
Practice Address - Fax:530-274-4472
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA367061223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U44763Medicare UPIN