Provider Demographics
NPI:1295973105
Name:HEARTLAND DENTAL CARE OF VIRGINIA, P.C. (FKA MILLER DDS, PC)
Entity type:Organization
Organization Name:HEARTLAND DENTAL CARE OF VIRGINIA, P.C. (FKA MILLER DDS, PC)
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5100
Mailing Address - Street 1:23520 OVERLAND DR STE 134
Mailing Address - Street 2:
Mailing Address - City:DULLES
Mailing Address - State:VA
Mailing Address - Zip Code:20166-2197
Mailing Address - Country:US
Mailing Address - Phone:703-661-3660
Mailing Address - Fax:703-661-3663
Practice Address - Street 1:23520 OVERLAND DR STE 134
Practice Address - Street 2:
Practice Address - City:DULLES
Practice Address - State:VA
Practice Address - Zip Code:20166-2197
Practice Address - Country:US
Practice Address - Phone:703-661-3660
Practice Address - Fax:703-661-3663
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND DENTAL CARE OF VIRGINIA, P.C. (FKA MILLER DDS, PC)
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty