Provider Demographics
NPI:1922540046
Name:NEW KENT DENTAL CARE
Entity Type:Organization
Organization Name:NEW KENT DENTAL CARE
Other - Org Name:NEW KENT DENTAL CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MCCRADY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, DDS
Authorized Official - Phone:804-405-6995
Mailing Address - Street 1:2690 DISPATCH RD
Mailing Address - Street 2:
Mailing Address - City:QUINTON
Mailing Address - State:VA
Mailing Address - Zip Code:23141-1726
Mailing Address - Country:US
Mailing Address - Phone:804-405-6995
Mailing Address - Fax:
Practice Address - Street 1:2690 DISPATCH RD
Practice Address - Street 2:
Practice Address - City:QUINTON
Practice Address - State:VA
Practice Address - Zip Code:23141-1726
Practice Address - Country:US
Practice Address - Phone:804-405-6995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008640122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty