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Organization
VALLEYGATE DENTAL SURGERY CENTER OF CHARLOTTE LLC
Active
Organization
VALLEYGATE DENTAL SURGERY CENTER OF CHARLOTTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VIRGINIA T JONES MAC, PHD (CEO)
(910) 485-7070
Entity
Organization
Contact information
Practice address
8415 MEDICAL PLAZA DR, CHARLOTTE, NC 28262-9768
(910) 485-7070
Mailing address
2028 LITHO PL STE 300, FAYETTEVILLE, NC 28304-2538
(910) 485-7070
(910) 485-1151
Taxonomy
Speciality
Code
Description
License number
State
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.)
—
—
2086S0127X
Trauma Surgery Physician
—
NULL
2086S0127X
Trauma Surgery Physician
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
NULL
363AM0700X
Medical Physician Assistant
—
NULL
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
06/25/2018
Last updated
10/09/2025
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