Provider Demographics
NPI:1538435284
Name:VALENTINE, KIRSTEN ANN
Entity type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:ANN
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KIRSTEN
Other - Middle Name:ANN
Other - Last Name:LARUSSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:10648 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-9015
Mailing Address - Country:US
Mailing Address - Phone:530-913-4966
Mailing Address - Fax:
Practice Address - Street 1:15301 TYLER FOOTE RD
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-9318
Practice Address - Country:US
Practice Address - Phone:530-292-3478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA375731223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry