Provider Demographics
NPI:1326134321
Name:GEORGE PLATHOTTAM DMD PC
Entity Type:Organization
Organization Name:GEORGE PLATHOTTAM DMD PC
Other - Org Name:INNSBROOK FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:VARKEY
Authorized Official - Last Name:PLATHOTTAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:804-270-9989
Mailing Address - Street 1:9840 B WEST BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060
Mailing Address - Country:US
Mailing Address - Phone:804-270-9989
Mailing Address - Fax:804-270-9296
Practice Address - Street 1:9840 B WEST BROAD ST
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060
Practice Address - Country:US
Practice Address - Phone:804-270-9989
Practice Address - Fax:804-270-9296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA110963Medicaid