Healthcare Provider Details

I. General information

NPI: 1538860804
Provider Name (Legal Business Name): JACQUELINE CULVER LANIGAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 IRVINGTON RD
KILMARNOCK VA
22482-3826
US

IV. Provider business mailing address

PO BOX 129
KILMARNOCK VA
22482-0129
US

V. Phone/Fax

Practice location:
  • Phone: 804-435-1220
  • Fax:
Mailing address:
  • Phone: 804-435-1220
  • 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: JACQUELINE LANIGAIN
Title or Position: DENTIST
Credential: DMD
Phone: 703-593-5422