Healthcare Provider Details

I. General information

NPI: 1922641935
Provider Name (Legal Business Name): CENTRAL VIRGINIA DENTAL CARE, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 HUNGARY SPRING RD
HENRICO VA
23228-2420
US

IV. Provider business mailing address

3000 HUNGARY SPRING RD
HENRICO VA
23228-2420
US

V. Phone/Fax

Practice location:
  • Phone: 804-501-0816
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HARINI REDDY
Title or Position: DENTIST
Credential:
Phone: 804-364-5043