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NPI Code Detail

MEDICARE: DENTAL PROFESSIONALS OF VIRGINIA, P.C.

MEDICARE: DENTAL PROFESSIONALS OF VIRGINIA, P.C.
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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1598247405
Entity Type Code : Organization
Provider Name (Legal Business Name) : DENTAL PROFESSIONALS OF VIRGINIA, P.C.
Provider Business Mailing Address
First Line : 125 BROWNS WAY RD
Second Line :
City : MIDLOTHIAN
State : VA
Zip : 23114-9507
Country : US
Telephone Number : 804-378-0082
Fax Number :
Provider Business Practice Location Address
First Line : 125 BROWNS WAY RD
Second Line :
City : MIDLOTHIAN
State : VA
Zip : 23114-9507
Country : US
Telephone Number : 804-378-0082
Fax Number :
Authorized Official
Title or Position : CREDENTIALING TEAM LEAD
Name : CASSANDRA PETERSEN
Credential :
Telephone Number : 217-540-8972
Provider Enumeration Date : 09/06/2018
Last Update Date : 09/06/2018

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Directions to “DENTAL PROFESSIONALS OF VIRGINIA, P.C. ” Practice Location

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