Provider Demographics
NPI:1821439670
Name:WALDREP & WALDREP, DMD, PLLC
Entity Type:Organization
Organization Name:WALDREP & WALDREP, DMD, PLLC
Other - Org Name:WALDREP FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALDREP
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:828-264-3211
Mailing Address - Street 1:450 NEW MARKET BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5501
Mailing Address - Country:US
Mailing Address - Phone:828-264-3211
Mailing Address - Fax:828-264-0677
Practice Address - Street 1:450 NEW MARKET BLVD STE 4
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5501
Practice Address - Country:US
Practice Address - Phone:828-264-3211
Practice Address - Fax:828-264-0677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty