Provider Demographics
NPI:1225678931
Name:WADHWA, REKHA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:REKHA
Middle Name:
Last Name:WADHWA
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 PRESS WAY
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:SC
Mailing Address - Zip Code:29670-9288
Mailing Address - Country:US
Mailing Address - Phone:504-231-5658
Mailing Address - Fax:
Practice Address - Street 1:100 WOODRUFF PLACE CIR
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-3672
Practice Address - Country:US
Practice Address - Phone:864-676-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC95211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics