MEDICARE: STEVE PLEICKHARDT DDS PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	0401006530	VA

General Provider Information

NPI Number	:	1073004503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVE PLEICKHARDT DDS PLC

Provider Business Mailing Address
First Line	:	7371 ATLAS WALK WAY # 615
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-2992
Country	:	US
Telephone Number	:	703-753-6695
Fax Number	:	703-753-6694

Provider Business Practice Location Address
First Line	:	9070 DEVLIN RD STE 110
Second Line	:
City	:	BRISTOW
State	:	VA
Zip	:	20136-1042
Country	:	US
Telephone Number	:	703-753-6695
Fax Number	:	703-753-6694

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEVE THOMAS PLEICKHARDT
Credential	:	DDS
Telephone Number	:	703-753-6695

Provider Enumeration Date	:	05/21/2018
Last Update Date	:	07/12/2024

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