MEDICARE: DR. JUSTIN RANDOLPH VALENTINE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	9004	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861703829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN RANDOLPH VALENTINE DDS

Provider Business Mailing Address
First Line	:	6934 BEACH DR SW
Second Line	:
City	:	OCEAN ISLE BEACH
State	:	NC
Zip	:	28469-5797
Country	:	US
Telephone Number	:	910-777-8660
Fax Number	:

Provider Business Practice Location Address
First Line	:	6934 BEACH DR SW
Second Line	:
City	:	OCEAN ISLE BEACH
State	:	NC
Zip	:	28469-5797
Country	:	US
Telephone Number	:	804-475-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2010
Last Update Date	:	02/13/2012

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