Provider Demographics
NPI:1609872514
Name:WADDELL, VALERIE HOLMES (DDS)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:HOLMES
Last Name:WADDELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 WOODLEIGH DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-8817
Mailing Address - Country:US
Mailing Address - Phone:704-868-4999
Mailing Address - Fax:704-868-4999
Practice Address - Street 1:3044 E FRANKLIN BLVD STE 4
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-9485
Practice Address - Country:US
Practice Address - Phone:704-865-5252
Practice Address - Fax:704-869-9698
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC60401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8998809Medicaid
60001NMedicare UPIN