Provider Demographics
NPI:1396917415
Name:CENTRAL VIRGINIA ORTHODONTICS, P.C.
Entity type:Organization
Organization Name:CENTRAL VIRGINIA ORTHODONTICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES. CENTRAL VIRGINIA ORTHONTICS
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:EDISON
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:434-385-4746
Mailing Address - Street 1:104 RICHESON DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-2905
Mailing Address - Country:US
Mailing Address - Phone:434-385-4746
Mailing Address - Fax:434-385-0523
Practice Address - Street 1:104 RICHESON DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2905
Practice Address - Country:US
Practice Address - Phone:434-385-4746
Practice Address - Fax:434-385-0523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010065971223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty