Provider Demographics
NPI:1740037019
Name:PRO DENTAL VA 1, P.C.
Entity type:Organization
Organization Name:PRO DENTAL VA 1, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-616-0292
Mailing Address - Street 1:10 WOODBRIDGE CENTER DR STE 520
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-1152
Mailing Address - Country:US
Mailing Address - Phone:732-616-0292
Mailing Address - Fax:
Practice Address - Street 1:6084 SAM SNEAD HWY
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:VA
Practice Address - Zip Code:24445-2664
Practice Address - Country:US
Practice Address - Phone:540-684-3765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental