Provider Demographics
NPI:1417977265
Name:BELLGRADE DENTAL CENTER PLC
Entity Type:Organization
Organization Name:BELLGRADE DENTAL CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:THEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-794-6900
Mailing Address - Street 1:2611 PROMENADE PKWY
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-1431
Mailing Address - Country:US
Mailing Address - Phone:804-794-6900
Mailing Address - Fax:804-794-7974
Practice Address - Street 1:2611 PROMENADE PKWY
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-1431
Practice Address - Country:US
Practice Address - Phone:804-794-6900
Practice Address - Fax:804-794-7974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4252 & 04014110771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAAH5122837OtherDEA #
VABT9339739OtherDEA #