Provider Demographics
NPI:1275853095
Name:DENTAL PROFESSIONALS OF VIRGINIA, P.C
Entity Type:Organization
Organization Name:DENTAL PROFESSIONALS OF VIRGINIA, P.C
Other - Org Name:DENTAL CARE AT OYSTER POINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:635 PILOT HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1980
Mailing Address - Country:US
Mailing Address - Phone:757-873-2777
Mailing Address - Fax:757-873-2444
Practice Address - Street 1:635 PILOT HOUSE DR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-1980
Practice Address - Country:US
Practice Address - Phone:757-873-2777
Practice Address - Fax:757-873-2444
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PROFESSIONALS OF VIRGINIA, P.C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-03
Last Update Date:2014-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty