MEDICARE: VALERIE HOLMES WADDELL DDS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6040	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609872514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE HOLMES WADDELL DDS

Provider Business Mailing Address
First Line	:	216 WOODLEIGH DR
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28056-8817
Country	:	US
Telephone Number	:	704-868-4999
Fax Number	:	704-868-4999

Provider Business Practice Location Address
First Line	:	3044 E FRANKLIN BLVD STE 4
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28056-9485
Country	:	US
Telephone Number	:	704-865-5252
Fax Number	:	704-869-9698

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	08/01/2008

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