Provider Demographics
NPI:1114661576
Name:PRIME DENTAL CARE PLLC
Entity Type:Organization
Organization Name:PRIME DENTAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JASWINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-366-2682
Mailing Address - Street 1:14361 STONEWATER CT
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-5731
Mailing Address - Country:US
Mailing Address - Phone:301-366-2682
Mailing Address - Fax:
Practice Address - Street 1:12719 APOLLO DR
Practice Address - Street 2:
Practice Address - City:DALE CITY
Practice Address - State:VA
Practice Address - Zip Code:22193
Practice Address - Country:US
Practice Address - Phone:301-366-2682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty