Provider Demographics
NPI:1043630569
Name:POWHATAN GENTLE DENTISTRY PLC
Entity Type:Organization
Organization Name:POWHATAN GENTLE DENTISTRY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-598-8951
Mailing Address - Street 1:2105 ACADEMY RD
Mailing Address - Street 2:UNIT J
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-5829
Mailing Address - Country:US
Mailing Address - Phone:804-598-8951
Mailing Address - Fax:804-598-7527
Practice Address - Street 1:2105 ACADEMY RD
Practice Address - Street 2:UNIT J
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-5829
Practice Address - Country:US
Practice Address - Phone:804-598-8951
Practice Address - Fax:804-598-7527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410103122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty