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General NPI Number Information
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NPI Number | 1043630569
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Entity Type | Organization
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Legal Business Name | POWHATAN GENTLE DENTISTRY PLC
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Dates
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Enumeration Date | 04/23/2014
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Last Update Date | 05/01/2014
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Provider Practice Location Address
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Address Line | 2105 ACADEMY RD UNIT J
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City | POWHATAN
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State | VA
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Zip | 23139-5829
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Country | US
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Telephone | 804-598-8951
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Fax | 804-598-7527
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Provider Business Mailing Address
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Address Line | 2105 ACADEMY RD UNIT J
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City | POWHATAN
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State | VA
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Zip | 23139-5829
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Country | US
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Telephone | 804-598-8951
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Fax | 804-598-7527
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Authorized Official
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Title or Position | DENTIST AND OWNER
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Name | DR. GENEVIEVE DEVERA
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Credential |
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Telephone | 804-598-8951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401410103
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License Number State | VA
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