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General NPI Number Information
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NPI Number | 1609104520
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Entity Type | Organization
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Legal Business Name | COMMUNITY DENTAL INC
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Dates
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Enumeration Date | 12/04/2009
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Last Update Date | 12/04/2009
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Provider Practice Location Address
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Address Line | 10246 KINGS HWY
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City | KING GEORGE
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State | VA
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Zip | 22485-3429
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Country | US
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Telephone | 540-498-3190
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Fax |
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Provider Business Mailing Address
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Address Line | 10246 KINGS HWY
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City | KING GEORGE
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State | VA
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Zip | 22485-3429
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Country | US
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Telephone | 540-498-3190
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD COTTRELL
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Credential | DDS
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Telephone | 540-498-3190
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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 | 0401411484
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401412194
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401008855
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License Number State | VA
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