Provider Demographics
NPI:1215059845
Name:VALENTA, RANDAL LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:LEE
Last Name:VALENTA
Suffix:
Gender:M
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:PO BOX 480
Mailing Address - Street 2:1838 DUNLAP AVE
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-0480
Mailing Address - Country:US
Mailing Address - Phone:715-735-5626
Mailing Address - Fax:715-735-3283
Practice Address - Street 1:1838 DUNLAP AVE
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-1722
Practice Address - Country:US
Practice Address - Phone:715-735-5626
Practice Address - Fax:715-735-3283
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice