Provider Demographics
NPI:1114529252
Name:UNITED SMILES GLEN ALLEN PC
Entity Type:Organization
Organization Name:UNITED SMILES GLEN ALLEN PC
Other - Org Name:UNITED SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:PLATHOTTAM
Authorized Official - Last Name:VARKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:804-874-2333
Mailing Address - Street 1:723 SOUTHPARK BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-3628
Mailing Address - Country:US
Mailing Address - Phone:804-504-0012
Mailing Address - Fax:804-490-0174
Practice Address - Street 1:5332 WYNDHAM FOREST DR
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5941
Practice Address - Country:US
Practice Address - Phone:804-504-0012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty