Provider Demographics
NPI:1144492950
Name:VALERIE A. WYNNE-HALL, D.D.S., M.P.H., P.A.
Entity type:Organization
Organization Name:VALERIE A. WYNNE-HALL, D.D.S., M.P.H., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:ALLAYNE
Authorized Official - Last Name:WYNNE-HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MPH, PA
Authorized Official - Phone:910-424-7665
Mailing Address - Street 1:4146 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-2325
Mailing Address - Country:US
Mailing Address - Phone:910-424-7665
Mailing Address - Fax:910-426-1816
Practice Address - Street 1:4146 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-2325
Practice Address - Country:US
Practice Address - Phone:910-424-7665
Practice Address - Fax:910-426-1816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4699261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental