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General NPI Number Information
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NPI Number | 1841542255
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Entity Type | Organization
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Legal Business Name | CHESTERFIELD DENTAL CENTER PLLC
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Dates
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Enumeration Date | 10/09/2012
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | 4909 NINE MILE RD SUITE A-40
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City | RICHMOND
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State | VA
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Zip | 23223-5738
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Country | US
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Telephone | 804-379-7855
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Fax | 804-379-2159
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Provider Business Mailing Address
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Address Line | 30 COURTHOUSE RD
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-3124
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Country | US
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Telephone | 804-379-7855
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Fax | 804-379-2159
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL PATRICK MCQUADE
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Credential | D.D.S
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Telephone | 804-901-7855
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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 | 0401006145
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License Number State | VA
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