Provider Demographics
NPI:1861688202
Name:MID ATLANTIC IMPLANT AND ORAL SURGERY CENTER P.C.
Entity Type:Organization
Organization Name:MID ATLANTIC IMPLANT AND ORAL SURGERY CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:FOLCK
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-340-9146
Mailing Address - Street 1:3145 VIRGINIA BEACH BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-6950
Mailing Address - Country:US
Mailing Address - Phone:757-340-9146
Mailing Address - Fax:757-340-2547
Practice Address - Street 1:3145 VIRGINIA BEACH BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-6950
Practice Address - Country:US
Practice Address - Phone:757-340-9146
Practice Address - Fax:757-340-2547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty