Provider Demographics
NPI:1144772740
Name:SPECIALITY DENTAL PARTNERS OF VIRGINIA PLLC
Entity Type:Organization
Organization Name:SPECIALITY DENTAL PARTNERS OF VIRGINIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-348-5222
Mailing Address - Street 1:125 HELLE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DUNDEE
Mailing Address - State:MI
Mailing Address - Zip Code:48131-9594
Mailing Address - Country:US
Mailing Address - Phone:734-348-5222
Mailing Address - Fax:
Practice Address - Street 1:125 HELLE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:DUNDEE
Practice Address - State:MI
Practice Address - Zip Code:48131-9594
Practice Address - Country:US
Practice Address - Phone:734-348-5222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-30
Last Update Date:2016-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010049541223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty