Provider Demographics
NPI:1881925667
Name:VALENTINE, JOHN W (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
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 1:12692 TAMIAMI TRL E
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-8431
Mailing Address - Country:US
Mailing Address - Phone:239-417-6453
Mailing Address - Fax:239-775-6628
Practice Address - Street 1:12692 TAMIAMI TRL E
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-8431
Practice Address - Country:US
Practice Address - Phone:239-417-6453
Practice Address - Fax:239-775-6628
Is Sole Proprietor?:No
Enumeration Date:2010-01-19
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0014676122300000X
FLDN146761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist