Healthcare Provider Details

I. General information

NPI: 1669624755
Provider Name (Legal Business Name): KENNETH A. YORGEY DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 ROCK CREEK VILLA DR SUITE F
QUINTON VA
23141-1656
US

IV. Provider business mailing address

3215 ROCK CREEK VILLA DR SUITE F
QUINTON VA
23141-1656
US

V. Phone/Fax

Practice location:
  • Phone: 804-932-5396
  • Fax: 804-932-5399
Mailing address:
  • Phone: 804-932-5396
  • Fax: 804-932-5399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number0401412111
License Number StateVA

VIII. Authorized Official

Name: DR. KENNETH ALLEN YORGEY
Title or Position: PRESIDENT
Credential: DMD
Phone: 804-932-5396