Provider Demographics
NPI:1235582974
Name:THE FOLECK CENTER, LTD.
Entity Type:Organization
Organization Name:THE FOLECK CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TANJA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANOJLOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-467-6000
Mailing Address - Street 1:4732 PRINCESS ANNE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6405
Mailing Address - Country:US
Mailing Address - Phone:757-467-6000
Mailing Address - Fax:757-467-8513
Practice Address - Street 1:4732 PRINCESS ANNE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6405
Practice Address - Country:US
Practice Address - Phone:757-467-6000
Practice Address - Fax:757-467-8513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010088731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty