Provider Demographics
NPI:1437595899
Name:DENTAL PROFESSIONALS OF VIRGINIA, P.C
Entity Type:Organization
Organization Name:DENTAL PROFESSIONALS OF VIRGINIA, P.C
Other - Org Name:STAUNTON DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING/INSURANCE
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 1:1600 N COALTER ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-2551
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 N COALTER ST
Practice Address - Street 2:SUITE 304
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-2551
Practice Address - Country:US
Practice Address - Phone:217-540-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PROFESSIONALS OF VIRGINIA, P.C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-13
Last Update Date:2014-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty