Provider Demographics
NPI:1881192755
Name:DENTAL ASSOCIATES OF VIRGINIA PC
Entity Type:Organization
Organization Name:DENTAL ASSOCIATES OF VIRGINIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:LIND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-741-9251
Mailing Address - Street 1:PO BOX 1247
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-1247
Mailing Address - Country:US
Mailing Address - Phone:218-741-9251
Mailing Address - Fax:
Practice Address - Street 1:108 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2519
Practice Address - Country:US
Practice Address - Phone:218-741-9251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty