Provider Demographics
NPI:1518372283
Name:PROGRESSIVE DENTAL OF FREDERICKSBURG
Entity Type:Organization
Organization Name:PROGRESSIVE DENTAL OF FREDERICKSBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCAVOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-785-3733
Mailing Address - Street 1:1239 CENTRAL PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4912
Mailing Address - Country:US
Mailing Address - Phone:540-785-3733
Mailing Address - Fax:540-785-0939
Practice Address - Street 1:1239 CENTRAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-1003
Practice Address - Country:US
Practice Address - Phone:434-851-8835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-21
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006911122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty