Provider Demographics
NPI:1073786299
Name:CHESTERFIELD DENTAL CENTER
Entity Type:Organization
Organization Name:CHESTERFIELD DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MCQUADE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-379-7855
Mailing Address - Street 1:30 COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3124
Mailing Address - Country:US
Mailing Address - Phone:804-379-7855
Mailing Address - Fax:804-379-2159
Practice Address - Street 1:30 COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23236-3124
Practice Address - Country:US
Practice Address - Phone:804-379-7855
Practice Address - Fax:804-379-2159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1140507261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9181303Medicaid
VA0007105Medicaid