Provider Demographics
NPI:1790391381
Name:US MEADOWDALE PC
Entity Type:Organization
Organization Name:US MEADOWDALE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:VARKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:804-743-3490
Mailing Address - Street 1:723 SOUTHPARK BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-3628
Mailing Address - Country:US
Mailing Address - Phone:804-504-0012
Mailing Address - Fax:
Practice Address - Street 1:4106A MEADOWDALE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-5503
Practice Address - Country:US
Practice Address - Phone:804-743-3490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty