Provider Demographics
NPI:1073403598
Name:VALENTINE, KAYLA ALEXIS
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:ALEXIS
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 GINGER DR
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE FORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23140-3585
Mailing Address - Country:US
Mailing Address - Phone:478-342-9538
Mailing Address - Fax:
Practice Address - Street 1:4680 MONTICELLO AVE STE 16A
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-8214
Practice Address - Country:US
Practice Address - Phone:757-258-1042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401419582122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist