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
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1992025134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL PROFESSIONALS OF VIRGINIA, P.C

Provider Business Mailing Address
First Line	:	4530 PROFESSIONAL CIR
Second Line	:	MORRISON ROAD, SUITE A
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6441
Country	:	US
Telephone Number	:	757-499-0567
Fax Number	:

Provider Business Practice Location Address
First Line	:	4530 PROFESSIONAL CIR
Second Line	:	MORRISON ROAD, SUITE A
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6441
Country	:	US
Telephone Number	:	757-499-0567
Fax Number	:

Authorized Official
Title or Position	:	INSURANCE COORDINATOR
Name	:	CARMEN WOODS
Credential	:
Telephone Number	:	217-540-5100

Provider Enumeration Date	:	06/10/2010
Last Update Date	:	01/11/2014

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