MEDICARE: TWO RIVERS FAMILY AND COSMETIC DENTISTRY

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	1223G0001X	General Practice Dentistry		VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	817581	OTHER	VA	UCCI

General Provider Information

NPI Number	:	1235225202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWO RIVERS FAMILY AND COSMETIC DENTISTRY

Provider Business Mailing Address
First Line	:	113 HAMPTON HIGHWAY
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23693-3510
Country	:	US
Telephone Number	:	757-867-8765
Fax Number	:	757-867-8500

Provider Business Practice Location Address
First Line	:	113 HAMPTON HIGHWAY
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23693-3510
Country	:	US
Telephone Number	:	757-867-8765
Fax Number	:	757-867-8500

Authorized Official
Title or Position	:	OWNER/PARTNER
Name	:	RICHARD WORDEN LACHINE III
Credential	:	DDS
Telephone Number	:	757-867-8765

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	01/29/2026

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