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General NPI Number Information
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NPI Number | 1073064317
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Entity Type | Organization
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Legal Business Name | CENTRAL VIRGINIA DENTAL CARE, PLC
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Dates
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Enumeration Date | 10/21/2016
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 3215 ROCK CREEK VILLA DRIVE SUITE F
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City | QUINTON
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State | VA
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Zip | 23141
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Country | US
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Telephone | 804-932-5396
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Fax |
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Provider Business Mailing Address
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Address Line | 3215 ROCK CREEK VILLA DRIVE SUITE F
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City | QUINTON
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State | VA
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Zip | 23141
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Country | US
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Telephone | 804-932-5396
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | LAURI HENDERSON
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Credential |
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Telephone | 804-897-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401412111
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License Number State | VA
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