Healthcare Provider Details

I. General information

NPI: 1598401820
Provider Name (Legal Business Name): CENTRAL VIRGINIA DENTAL CARE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 05/10/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13295 RIVERS BEND BLVD
CHESTER VA
23836-8610
US

IV. Provider business mailing address

13295 RIVERS BEND BLVD
CHESTER VA
23836-8610
US

V. Phone/Fax

Practice location:
  • Phone: 804-530-3539
  • Fax: 804-530-5617
Mailing address:
  • Phone: 804-530-3539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL RAYMOND HANLEY
Title or Position: DENTIST
Credential: DDS
Phone: 804-530-3539