MEDICARE: VIRGINIA BEACH DENTAL SPA, PLLC

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	261QD0000X	Dental Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386118990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRGINIA BEACH DENTAL SPA, PLLC

Provider Business Mailing Address
First Line	:	9305 QUIOCCASIN RD STE A
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23229-5429
Country	:	US
Telephone Number	:	804-251-1233
Fax Number	:	804-750-1880

Provider Business Practice Location Address
First Line	:	9305 QUIOCCASIN RD STE A
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23229-5429
Country	:	US
Telephone Number	:	804-251-1233
Fax Number	:	804-750-1880

Authorized Official
Title or Position	:	OWNER
Name	:	FIRAS ALBADRAN
Credential	:
Telephone Number	:	617-505-7082

Provider Enumeration Date	:	01/16/2019
Last Update Date	:	01/16/2019

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