Healthcare Provider Details

I. General information

NPI: 1417571621
Provider Name (Legal Business Name): LORI VALENTINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4675 VAN DYKE RD
LUTZ FL
33558-4880
US

IV. Provider business mailing address

1415 SWEETWATER CV UNIT 202
NAPLES FL
34110-4138
US

V. Phone/Fax

Practice location:
  • Phone: 813-437-9710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN25677
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: