MEDICARE: VALLEYGATE DENTAL SURGERY CENTER OF CHARLOTTE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207L00000X	Anesthesiology Physician
2	207LP3000X	Pediatric Anesthesiology Physician
3	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1043191661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEYGATE DENTAL SURGERY CENTER OF CHARLOTTE LLC

Provider Business Mailing Address
First Line	:	13515 STEELE CREEK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28273-6839
Country	:	US
Telephone Number	:	910-485-7070
Fax Number	:	910-500-6972

Provider Business Practice Location Address
First Line	:	13515 STEELE CREEK RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28273-0088
Country	:	US
Telephone Number	:	910-485-7070
Fax Number	:	910-500-6972

Authorized Official
Title or Position	:	REVENUE CYCLE MANAGER
Name	:	JENNIFER DIGIACOMO
Credential	:
Telephone Number	:	910-484-7070

Provider Enumeration Date	:	09/10/2025
Last Update Date	:	03/12/2026

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