Provider Demographics
NPI:1245781970
Name:MIDLOTHIAN DENTAL CENTER
Entity Type:Organization
Organization Name:MIDLOTHIAN DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LAURI
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-363-4283
Mailing Address - Street 1:14431 SOMMERVILLE CT
Mailing Address - Street 2:STE.A
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-6812
Mailing Address - Country:US
Mailing Address - Phone:804-794-4588
Mailing Address - Fax:
Practice Address - Street 1:14431 SOMMERVILLE CT
Practice Address - Street 2:STE.A
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-6812
Practice Address - Country:US
Practice Address - Phone:804-794-4588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL VIRGINIA DENTAL CENTER PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty