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General NPI Number Information
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NPI Number | 1619881596
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Entity Type | Organization
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Legal Business Name | PREMIER CARE DENTISTRY OF VIRGINA
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Dates
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Enumeration Date | 09/29/2026
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | 4501 S LABURNUM AVE STE 540
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City | HENRICO
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State | VA
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Zip | 23231-2494
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Country | US
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Telephone | 804-567-8460
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Fax |
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Provider Business Mailing Address
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Address Line | 105 MAXESS RD STE 107N
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City | MELVILLE
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State | NY
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Zip | 11747-3859
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Country | US
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Telephone | 631-414-7927
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING OPERATIONS MANAGER
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Name | ANGELA SWAIN
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Credential |
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Telephone | 516-344-5746
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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 |
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License Number State | NULL
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