Provider Demographics
NPI:1073991204
Name:THE VILLAGE DENTAL CARE, PA
Entity Type:Organization
Organization Name:THE VILLAGE DENTAL CARE, PA
Other - Org Name:VILLAGE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:HALL
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-205-7667
Mailing Address - Street 1:PO BOX 1900
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32158-1900
Mailing Address - Country:US
Mailing Address - Phone:352-205-7667
Mailing Address - Fax:352-205-8754
Practice Address - Street 1:2532 BURNSED BLVD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-2704
Practice Address - Country:US
Practice Address - Phone:352-205-7667
Practice Address - Fax:352-205-8754
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE VILLAGE DENTAL CARE, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty