Provider Demographics
NPI:1033560214
Name:MOONEY, VALERIE ELAINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:ELAINE
Last Name:MOONEY
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 1:573 TAYRN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8238
Mailing Address - Country:US
Mailing Address - Phone:828-768-1415
Mailing Address - Fax:
Practice Address - Street 1:1724 STATE RD UNIT 4D
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-2842
Practice Address - Country:US
Practice Address - Phone:843-352-4454
Practice Address - Fax:828-652-3690
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10349122300000X
SC104221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist