Provider Demographics
NPI:1083827893
Name:HEARTLAND DENTAL CARE OF VIRGINIA, P.C
Entity Type:Organization
Organization Name:HEARTLAND DENTAL CARE OF VIRGINIA, P.C
Other - Org Name:REFLECTION DENTAL WEST END
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INS COOD
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KROEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:5249 DUKE ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2926
Mailing Address - Country:US
Mailing Address - Phone:703-212-7500
Mailing Address - Fax:703-212-7056
Practice Address - Street 1:5249 DUKE ST
Practice Address - Street 2:SUITE 410
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2926
Practice Address - Country:US
Practice Address - Phone:703-212-7500
Practice Address - Fax:703-212-7056
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND DENTAL CARE OF VIRGINIA, P.C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-08
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty