Provider Demographics
NPI:1982124095
Name:JACKSON, VALENCIA DENEASE BARNES (DDS)
Entity Type:Individual
Prefix:DR
First Name:VALENCIA
Middle Name:DENEASE BARNES
Last Name:JACKSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:VALENCIA
Other - Middle Name:DENEASE
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:260 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35042-2332
Mailing Address - Country:US
Mailing Address - Phone:205-926-4697
Mailing Address - Fax:
Practice Address - Street 1:623 8TH AVE W
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35204-3604
Practice Address - Country:US
Practice Address - Phone:205-545-7696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.0006845122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist