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General NPI Number Information
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NPI Number | 1285819912
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Entity Type | Organization
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Legal Business Name | HEATHCOTE DENTAL PLC
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 12/31/2007
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Provider Practice Location Address
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Address Line | 7450 HERITAGE VILLAGE PLAZA SUITE 102
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City | GAINESVILLE
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State | VA
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Zip | 20155-3091
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Country | US
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Telephone | 571-248-6585
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Fax | 571-248-6587
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Provider Business Mailing Address
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Address Line | 7450 HERITAGE VILLAGE PLAZA SUITE 102
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City | GAINESVILLE
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State | VA
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Zip | 20155-3091
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Country | US
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Telephone | 571-248-6585
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Fax | 571-248-6587
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Authorized Official
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Title or Position | OWNER
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Name | DR. LLOYD MICHAEL ROGERS
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Credential |
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Telephone | 571-248-6585
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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 | 0401411984
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401411037
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License Number State | VA
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