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General NPI Number Information
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NPI Number | 1912459215
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Entity Type | Organization
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Legal Business Name | CENTRAL VIRGINIA DENTAL CARE PLC
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Dates
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Enumeration Date | 11/03/2016
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Last Update Date | 10/22/2021
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Provider Practice Location Address
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Address Line | 8203 CENTER PATH LANE SUITE A
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-4060
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Country | US
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Telephone | 804-746-7382
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Fax | 804-368-1448
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Provider Business Mailing Address
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Address Line | 8203 CENTER PATH LANE SUITE A
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-4060
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Country | US
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Telephone | 804-746-7382
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Fax | 804-368-1448
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Authorized Official
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Title or Position | OWNER/PEDIATRIC DENTAL SPECIALIST
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Name | MRS. HOLLY CHRISTEL LEWIS
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Credential | DMD, MS
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Telephone | 804-746-7382
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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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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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