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General NPI Number Information
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NPI Number | 1831499714
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Entity Type | Organization
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Legal Business Name | PLAZA DRIVE FAMILY & COSMETIC DENTISTRY, PC
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Dates
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Enumeration Date | 10/26/2010
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Last Update Date | 10/26/2010
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Provider Practice Location Address
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Address Line | 1800 W PLAZA DR
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City | WINCHESTER
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State | VA
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Zip | 22601-6365
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Country | US
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Telephone | 540-667-1010
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Fax | 540-667-1074
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Provider Business Mailing Address
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Address Line | 1800 W PLAZA DR
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City | WINCHESTER
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State | VA
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Zip | 22601-6365
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Country | US
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Telephone | 540-667-1010
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Fax | 540-667-1074
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SONYA L MURPHY
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Credential |
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Telephone | 540-667-1010
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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 | 10907
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6373
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License Number State | VA
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