MEDICARE: DENTAL FIRST PLC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1154755445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL FIRST PLC

Provider Business Mailing Address
First Line	:	14614 CHARTER WALK PL
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23114-4699
Country	:	US
Telephone Number	:	540-520-3507
Fax Number	:	800-676-9961

Provider Business Practice Location Address
First Line	:	104 MORTON AVE
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-2750
Country	:	US
Telephone Number	:	804-732-0056
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	FOUAD FAROOQI
Credential	:
Telephone Number	:	540-520-3507

Provider Enumeration Date	:	08/22/2013
Last Update Date	:	08/22/2013

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