Provider Demographics
NPI:1013387737
Name:POTOMAC VALLEY DENTAL CARE PLLC
Entity Type:Organization
Organization Name:POTOMAC VALLEY DENTAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:HARKINS
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-830-9110
Mailing Address - Street 1:14245P CENTREVILLE SQ
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2368
Mailing Address - Country:US
Mailing Address - Phone:703-830-9110
Mailing Address - Fax:703-830-1632
Practice Address - Street 1:14245P CENTREVILLE SQ
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2368
Practice Address - Country:US
Practice Address - Phone:703-830-9110
Practice Address - Fax:703-830-1632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty