Provider Demographics
NPI:1568820702
Name:SMILES OF VIRGINIA FAMILY DENTAL CENTER, PLLC
Entity Type:Organization
Organization Name:SMILES OF VIRGINIA FAMILY DENTAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIELS
Authorized Official - Middle Name:
Authorized Official - Last Name:OESTERVEMB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-936-9008
Mailing Address - Street 1:633 CEDAR CREEK GRADE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2708
Mailing Address - Country:US
Mailing Address - Phone:540-450-2100
Mailing Address - Fax:
Practice Address - Street 1:633 CEDAR CREEK GRADE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2708
Practice Address - Country:US
Practice Address - Phone:540-662-4328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental