Provider Demographics
NPI:1326596297
Name:CRANIOFACIAL PAIN AND DENTAL SLEEP CENTER OF VIRGINIA PLLC
Entity Type:Organization
Organization Name:CRANIOFACIAL PAIN AND DENTAL SLEEP CENTER OF VIRGINIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-351-0170
Mailing Address - Street 1:410 ROSEDALE CT
Mailing Address - Street 2:STE 170
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-4329
Mailing Address - Country:US
Mailing Address - Phone:540-351-0170
Mailing Address - Fax:877-262-7725
Practice Address - Street 1:410 ROSEDALE CT
Practice Address - Street 2:STE 170
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-4329
Practice Address - Country:US
Practice Address - Phone:540-351-0170
Practice Address - Fax:877-262-7725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty