# VALLEYGATE DENTAL SURGERY CENTER OF FAYETTEVILLE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Valleygate Dental Surgery Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003321365
- **Authorized official:** MRS. VIRGINIA JONES (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (910) 485-7070

## Contact information

- **Practice address:** 2038 LITHO PLACE, FAYETTEVILLE, NC 28304
- **Practice address phone:** (910) 485-7070
- **Practice address fax:** (910) 485-1151
- **Mailing address:** 2028 LITHO PL STE 300, FAYETTEVILLE, NC 28304-2538
- **Mailing address phone:** (910) 485-7070
- **Mailing address fax:** (910) 485-1151

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223D0004X | Dental Anesthesiology | — | NULL | — |
| 1223D0004X | Dental Anesthesiology | — | — | — |
| 1223E0200X | Endodontics | — | NULL | — |
| 1223E0200X | Endodontics | — | — | — |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | — | NULL | — |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | — | — | — |
| 1223P0221X | Pediatric Dentistry | — | NULL | — |
| 1223P0221X | Pediatric Dentistry | — | — | — |
| 1223P0300X | Periodontics | — | NULL | — |
| 1223P0300X | Periodontics | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | — |
| 1223X0008X | Oral and Maxillofacial Radiology Dentistry | — | NULL | — |
| 1223X0008X | Oral and Maxillofacial Radiology Dentistry | — | — | — |
| 163WP0200X | Pediatric Registered Nurse | — | NULL | — |
| 163WP0200X | Pediatric Registered Nurse | — | — | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | — |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | — |
| 207L00000X | Anesthesiology Physician | — | NULL | — |
| 207L00000X | Anesthesiology Physician | — | — | — |
| 2086S0127X | Trauma Surgery Physician | — | NULL | — |
| 2086S0127X | Trauma Surgery Physician | — | — | — |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/08/2017
- **Last updated:** 08/01/2025