Provider Demographics
NPI:1144904657
Name:VALENTINE, SARA GRACE (DMD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:GRACE
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 HOWARD RD
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-3715
Mailing Address - Country:US
Mailing Address - Phone:601-606-7456
Mailing Address - Fax:
Practice Address - Street 1:16690 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39339-2750
Practice Address - Country:US
Practice Address - Phone:662-773-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4373231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice