Healthcare Provider Details

I. General information

NPI: 1891282976
Provider Name (Legal Business Name): KAITLIN VALERIO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLIN NOWLING DDS

II. Dates (important events)

Enumeration Date: 04/15/2018
Last Update Date: 09/27/2020
Certification Date: 09/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 WILLIAMSON RD STE 200
MOORESVILLE NC
28117-7611
US

IV. Provider business mailing address

9808 HOLLY CENTER DR APT 109
HUNTERSVILLE NC
28078-5112
US

V. Phone/Fax

Practice location:
  • Phone: 704-360-8670
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number390200000X
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number11966
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: