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General NPI Number Information
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NPI Number | 1144904657
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Entity Type | Individual
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Provider Name | SARA GRACE VALENTINE DMD
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Gender | Female
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Dates
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Enumeration Date | 06/14/2023
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 16690 E MAIN ST
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City | LOUISVILLE
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State | MS
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Zip | 39339-2750
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Country | US
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Telephone | 662-773-4222
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Fax |
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Provider Business Mailing Address
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Address Line | 905 HOWARD RD
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City | STARKVILLE
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State | MS
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Zip | 39759-3715
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Country | US
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Telephone | 601-606-7456
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 437323
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License Number State | MS
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