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General NPI Number Information
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NPI Number | 1518130046
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Entity Type | Organization
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Legal Business Name | LISA M. VALENTINE, D.D.S LLC
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Dates
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Enumeration Date | 04/04/2008
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Last Update Date | 04/04/2008
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Provider Practice Location Address
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Address Line | 1111 PARK AVE SUITE L-109
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City | BALTIMORE
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State | MD
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Zip | 21201-5656
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Country | US
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Telephone | 410-383-7070
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Fax | 410-383-7070
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Provider Business Mailing Address
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Address Line | 1111 PARK AVE SUITE L-109
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City | BALTIMORE
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State | MD
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Zip | 21201-5656
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Country | US
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Telephone | 410-383-7070
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Fax | 410-383-7070
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Authorized Official
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Title or Position | OWNER
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Name | DR. LISA MARIE VALENTINE
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Credential | D.D.S
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Telephone | 410-383-7070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12365
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License Number State | MD
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