Provider Demographics
NPI:1942413042
Name:DENTAL PROFESSIONALS OF VIRGINIA, P.C
Entity Type:Organization
Organization Name:DENTAL PROFESSIONALS OF VIRGINIA, P.C
Other - Org Name:REFLECTION DENTAL MANASSAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INS COOD
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:9675 LIBERIA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-1741
Mailing Address - Country:US
Mailing Address - Phone:703-369-2323
Mailing Address - Fax:703-369-4854
Practice Address - Street 1:9675 LIBERIA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-1741
Practice Address - Country:US
Practice Address - Phone:703-369-2323
Practice Address - Fax:703-369-4854
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PROFESSIONALS OF VIRGINIA, P.C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-07
Last Update Date:2014-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty