Provider Demographics
NPI:1659427474
Name:VALERIE HOLMES WADDELL, DDS, PA
Entity Type:Organization
Organization Name:VALERIE HOLMES WADDELL, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:HOLMES
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-865-5252
Mailing Address - Street 1:1601 EAST GARRISON BOULEVARD
Mailing Address - Street 2:SUITE C
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5153
Mailing Address - Country:US
Mailing Address - Phone:704-865-5252
Mailing Address - Fax:704-865-3552
Practice Address - Street 1:1601 EAST GARRISON BOULEVARD
Practice Address - Street 2:SUITE C
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5153
Practice Address - Country:US
Practice Address - Phone:704-865-5252
Practice Address - Fax:704-865-3552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty