=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437216959
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GAIL V. PLAUKA, D.M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 JOHNSTOWN RD SUITE C
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23322-5365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-482-4777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 350 JOHNSTOWN RD SUITE C
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23322-5365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-482-4777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. JORDANA EFLAND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-482-4777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 0401006218
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------