Provider Demographics
NPI:1407456353
Name:MB. DENTAL CARE PLLC
Entity Type:Organization
Organization Name:MB. DENTAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAMESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-690-3005
Mailing Address - Street 1:14609 BRINDLE CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193
Mailing Address - Country:US
Mailing Address - Phone:703-589-7040
Mailing Address - Fax:
Practice Address - Street 1:12701 BRAEMAR VILLAGE PLZ
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-5501
Practice Address - Country:US
Practice Address - Phone:703-589-7040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MB, DENTAL CARE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-29
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty