Healthcare Provider Details

I. General information

NPI: 1972767200
Provider Name (Legal Business Name): MICHAEL B. HOLBERT, D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 N PARHAM RD SUITE #201
RICHMOND VA
23294-4412
US

IV. Provider business mailing address

2821 N PARHAM RD SUITE #201
RICHMOND VA
23294-4412
US

V. Phone/Fax

Practice location:
  • Phone: 804-270-7824
  • Fax: 804-270-6654
Mailing address:
  • Phone: 804-270-7824
  • Fax: 804-270-6654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401412060
License Number StateVA

VIII. Authorized Official

Name: DR. MICHAEL BURKE HOLBERT
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 804-270-7824