MEDICARE: UNITED SMILES GLEN ALLEN PC

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	122300000X	Dentist

General Provider Information

NPI Number	:	1114529252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED SMILES GLEN ALLEN PC

Provider Business Mailing Address
First Line	:	723 SOUTHPARK BLVD STE F
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-3628
Country	:	US
Telephone Number	:	804-504-0012
Fax Number	:	804-490-0174

Provider Business Practice Location Address
First Line	:	5332 WYNDHAM FOREST DR
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-5941
Country	:	US
Telephone Number	:	804-504-0012
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GEORGE PLATHOTTAM VARKEY
Credential	:	DMD
Telephone Number	:	804-874-2333

Provider Enumeration Date	:	11/13/2020
Last Update Date	:	01/12/2021

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