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General NPI Number Information
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NPI Number | 1922540046
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Entity Type | Organization
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Legal Business Name | NEW KENT DENTAL CARE
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Dates
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Enumeration Date | 11/07/2016
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Last Update Date | 11/07/2016
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Provider Practice Location Address
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Address Line | 2690 DISPATCH RD
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City | QUINTON
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State | VA
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Zip | 23141-1726
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Country | US
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Telephone | 804-405-6995
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Fax |
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Provider Business Mailing Address
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Address Line | 2690 DISPATCH RD
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City | QUINTON
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State | VA
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Zip | 23141-1726
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Country | US
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Telephone | 804-405-6995
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CARL WILLIAM MCCRADY
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Credential | PHD, DDS
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Telephone | 804-405-6995
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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 | 0401008640
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License Number State | VA
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