Healthcare Provider Details

I. General information

NPI: 1598838401
Provider Name (Legal Business Name): LOUISA DENTAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WOOLFOLK AVE STE 202
LOUISA VA
23093-4264
US

IV. Provider business mailing address

PO BOX 7546
CHARLOTTESVILLE VA
22906-7546
US

V. Phone/Fax

Practice location:
  • Phone: 540-967-4439
  • Fax: 540-967-4452
Mailing address:
  • Phone: 434-972-6219
  • Fax: 434-972-4310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. LILIAN R PEAKE
Title or Position: DIRECTOR
Credential: MD
Phone: 434-972-6219