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General NPI Number Information
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NPI Number | 1962813402
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Entity Type | Organization
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Legal Business Name | DENTAL PROFESSIONALS OF VIRGINIA, P.C.
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Dates
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Enumeration Date | 05/19/2014
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Last Update Date | 05/19/2014
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Provider Practice Location Address
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Address Line | 11549 NUCKOLS RD STE A
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City | GLEN ALLEN
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State | VA
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Zip | 23059-5664
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Country | US
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Telephone | 804-527-2982
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Fax | 804-527-2987
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Provider Business Mailing Address
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Address Line | 11549 NUCKOLS RD STE A
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City | GLEN ALLEN
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State | VA
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Zip | 23059-5664
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Country | US
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Telephone | 804-527-2982
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Fax | 804-527-2987
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Authorized Official
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Title or Position | CRED SUPERVISOR
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Name | KIM WILSON
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Credential |
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Telephone | 217-540-5170
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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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