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General NPI Number Information
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NPI Number | 1043191661
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Entity Type | Organization
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Legal Business Name | VALLEYGATE DENTAL SURGERY CENTER OF CHARLOTTE LLC
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Dates
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Enumeration Date | 09/10/2025
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 13515 STEELE CREEK RD
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City | CHARLOTTE
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State | NC
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Zip | 28273-6839
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Country | US
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Telephone | 910-485-7070
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Fax | 910-500-6972
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Provider Business Mailing Address
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Address Line | 13515 STEELE CREEK RD
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City | CHARLOTTE
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State | NC
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Zip | 28273-6839
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Country | US
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Telephone | 910-485-7070
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Fax | 910-500-6972
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Authorized Official
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Title or Position | REVENUE CYCLE MANAGER
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Name | JENNIFER DIGIACOMO
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Credential |
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Telephone | 910-484-7070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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