Individual provider Active NPI

John W Valentine, DMD

  • General Practice Dentistry
  • Naples, FL
National Provider Identifier
1881925667
Registry record updated Apr 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN14676 Issued in FL
Practice address
12692 Tamiami TRL E
Naples, FL 34113-8431
Phone
(239) 417-6453
Fax
(239) 775-6628
NPI assigned
Jan 19, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN0014676 FL
General Practice Dentistry 1223G0001X DN14676 FL Primary

Addresses

Primary practice location

12692 Tamiami TRL E
Naples, FL 34113-8431

Mailing address

12692 Tamiami TRL E
Naples, FL 34113-8431
Phone (239) 417-6453

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DN0014676FLMDDentist
DN14676FLMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Eagle Creek Dentistry, Inc. Dentist CurrentSince Jun 6, 2021 Accepting new patients
Smile Design Eagle Creek LLC General Practice PastSince Apr 11, 2021 Accepting new patients

Locations

12692 Tamiami Trl E
Naples, FL 34113
Phone (239) 417-6453

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1263859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617840000000",
    "number": "1881925667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12692 TAMIAMI TRL E",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341138431",
            "telephone_number": "239-417-6453",
            "fax_number": "239-775-6628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12692 TAMIAMI TRL E",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341138431",
            "telephone_number": "239-417-6453",
            "fax_number": "239-775-6628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALENTINE",
        "first_name": "JOHN",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-01-19",
        "last_updated": "2021-04-08",
        "certification_date": "2021-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN0014676",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN14676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Naples, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.