Provider Demographics
NPI:1487492047
Name:VALENTI, JORDIN RAE (DDS)
Entity type:Individual
Prefix:DR
First Name:JORDIN
Middle Name:RAE
Last Name:VALENTI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4327 US HIGHWAY 1 S
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-7278
Mailing Address - Country:US
Mailing Address - Phone:904-494-8630
Mailing Address - Fax:
Practice Address - Street 1:4327 US HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-7278
Practice Address - Country:US
Practice Address - Phone:904-494-8630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN294091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice