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General NPI Number Information
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NPI Number | 1730544784
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Entity Type | Organization
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Legal Business Name | SPA CREEK DENTAL OF VA, PLLC
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Dates
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Enumeration Date | 12/17/2015
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Last Update Date | 06/04/2021
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Provider Practice Location Address
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Address Line | 14540 JOHN MARSHALL HIGHWAY STE 103
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City | GAINESVILLE
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State | VA
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Zip | 20155
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Country | US
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Telephone | 267-691-2800
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Fax | 267-691-2830
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Provider Business Mailing Address
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Address Line | 626 JACKSONVILLE RD STE 101
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City | WARMINSTER
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State | PA
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Zip | 18974-4861
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Country | US
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Telephone | 877-772-3368
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Fax | 267-691-2830
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Authorized Official
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Title or Position | ACCOUNTS RECEIVABLE SPECIALIST
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Name | AMBER LLOYD
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Credential |
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Telephone | 267-691-2812
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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 |
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