Provider Demographics
NPI:1174259568
Name:DENTAL PROFESSIONALS OF VIRGINIA, P.C.
Entity Type:Organization
Organization Name:DENTAL PROFESSIONALS OF VIRGINIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:25739 BRANCH RAIL DR STE 160
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-4515
Mailing Address - Country:US
Mailing Address - Phone:571-430-3535
Mailing Address - Fax:571-430-3538
Practice Address - Street 1:25739 BRANCH RAIL DR STE 160
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-4515
Practice Address - Country:US
Practice Address - Phone:571-430-3535
Practice Address - Fax:571-430-3538
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND DENTAL CARE OF VIRGINIA, P.C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty