=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508781519
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARNUM STREET DENTAL SERVICES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2026
-----------------------------------------------------
Last Update Date | 08/11/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 BARNUM ST
-----------------------------------------------------
City | DUNDEE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48131-1110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-244-9011
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 RIVER PARK PL
-----------------------------------------------------
City | DUNDEE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48131-2026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-244-9011
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/SOLE MBR
-----------------------------------------------------
Name | DR. MICHAEL TODD VALENTINE
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 734-244-9011
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------