MEDICARE: MARK V. VALENTINAS DDS,PC

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	1223G0001X	General Practice Dentistry	019.017898	IL

General Provider Information

NPI Number	:	1932267101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK V. VALENTINAS DDS,PC

Provider Business Mailing Address
First Line	:	1001 E CHICAGO AVE
Second Line	:	#143
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-5526
Country	:	US
Telephone Number	:	630-369-0111
Fax Number	:	630-369-0378

Provider Business Practice Location Address
First Line	:	1001 E CHICAGO AVE
Second Line	:	#143
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-5526
Country	:	US
Telephone Number	:	630-369-0111
Fax Number	:	630-369-0378

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK VICTOR VALENTINAS
Credential	:	DDS
Telephone Number	:	630-369-0111

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/08/2008

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