MEDICARE: ATLANTIC DENTAL CARE, 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	122300000X	Dentist

General Provider Information

NPI Number	:	1831434711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC DENTAL CARE, PLC

Provider Business Mailing Address
First Line	:	737 LITTLE NECK RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-5813
Country	:	US
Telephone Number	:	757-486-4469
Fax Number	:	757-961-6882

Provider Business Practice Location Address
First Line	:	737 LITTLE NECK RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-5813
Country	:	US
Telephone Number	:	757-486-4469
Fax Number	:	757-961-6882

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	DR. CLAYBORN HENDRICKS
Credential	:	D.D.S.
Telephone Number	:	757-486-4469

Provider Enumeration Date	:	12/04/2012
Last Update Date	:	12/04/2012

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