MEDICARE: DR. REKHA WADHWA DDS, MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	9521	SC

General Provider Information

NPI Number	:	1225678931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REKHA WADHWA DDS, MS

Provider Business Mailing Address
First Line	:	209 PRESS WAY
Second Line	:
City	:	PENDLETON
State	:	SC
Zip	:	29670-9288
Country	:	US
Telephone Number	:	504-231-5658
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 WOODRUFF PLACE CIR
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29681-3672
Country	:	US
Telephone Number	:	864-676-9955
Fax Number	:

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

Provider Enumeration Date	:	01/10/2020
Last Update Date	:	01/10/2020

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