=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982124095
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VALENCIA DENEASE BARNES JACKSON DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2017
-----------------------------------------------------
Last Update Date | 09/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 18TH ST S UNIT 101
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35233-1875
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-701-4256
-----------------------------------------------------
Fax | 205-973-9966
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 18TH ST S UNIT 101
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35233-1875
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-701-4256
-----------------------------------------------------
Fax | 205-973-9966
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | D.0006845
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------