Provider Demographics
NPI:1124111968
Name:WYNNE-HALL, VALERIE ALLAYNE (DDS, MPH, PA)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:ALLAYNE
Last Name:WYNNE-HALL
Suffix:
Gender:F
Credentials:DDS, MPH, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:910-424-1816
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:910-424-1816
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC46991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice