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General NPI Number Information
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NPI Number | 1104253186
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Entity Type | Organization
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Legal Business Name | DENTAL PROFESSIONALS OF VIRGINIA, P.C
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Dates
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Enumeration Date | 10/04/2013
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Last Update Date | 01/11/2014
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Provider Practice Location Address
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Address Line | 43170 SOUTHERN WALK PLZ SUITE 116
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City | BROADLANDS
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State | VA
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Zip | 20148-4464
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Country | US
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Telephone | 703-957-7066
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Fax |
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Provider Business Mailing Address
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Address Line | 43170 SOUTHERN WALK PLZ SUITE 116
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City | BROADLANDS
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State | VA
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Zip | 20148-4464
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Country | US
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Telephone | 703-957-7066
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Fax |
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Authorized Official
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Title or Position | INSURANE/CREDENTIALING
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Name | LINDSAY BEARDEN
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Credential |
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Telephone | 217-540-5100
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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 |
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License Number State |
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