Provider Demographics
NPI:1326502568
Name:WADHWA, SUPNEET SINGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUPNEET
Middle Name:SINGH
Last Name:WADHWA
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 1:4287 HANNAH BELLE WAY
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-1149
Mailing Address - Country:US
Mailing Address - Phone:720-930-5014
Mailing Address - Fax:
Practice Address - Street 1:2913 ORANGE AVE NE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-6338
Practice Address - Country:US
Practice Address - Phone:540-342-8781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014163971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice