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General NPI Number Information
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NPI Number | 1790391381
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Entity Type | Organization
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Legal Business Name | US MEADOWDALE PC
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Dates
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Enumeration Date | 09/18/2020
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Last Update Date | 09/18/2020
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Provider Practice Location Address
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Address Line | 4106A MEADOWDALE BLVD
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23234-5503
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Country | US
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Telephone | 804-743-3490
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Fax |
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Provider Business Mailing Address
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Address Line | 723 SOUTHPARK BLVD STE F
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-3628
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Country | US
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Telephone | 804-504-0012
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GEORGE VARKEY
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Credential | DMD
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Telephone | 804-743-3490
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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 |
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License Number State |
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