Provider Demographics
NPI:1073901161
Name:DENTAL PROFESSIONALS OF VIRGINIA, P.C.
Entity Type:Organization
Organization Name:DENTAL PROFESSIONALS OF VIRGINIA, P.C.
Other - Org Name:SUFFOLK COMPLETE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5141
Mailing Address - Street 1:6225 COLLEGE DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-2768
Mailing Address - Country:US
Mailing Address - Phone:757-663-5716
Mailing Address - Fax:
Practice Address - Street 1:6255 COLLEGE DR
Practice Address - Street 2:SUITE E
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2768
Practice Address - Country:US
Practice Address - Phone:757-663-5716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUFFOLK COMPLETE DENTAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-26
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty