Provider Demographics
NPI:1841542255
Name:CHESTERFIELD DENTAL CENTER PLLC
Entity type:Organization
Organization Name:CHESTERFIELD DENTAL CENTER PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MCQUADE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-901-7855
Mailing Address - Street 1:30 COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3124
Mailing Address - Country:US
Mailing Address - Phone:804-379-7855
Mailing Address - Fax:804-379-2159
Practice Address - Street 1:4909 NINE MILE RD
Practice Address - Street 2:SUITE A-40
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-5738
Practice Address - Country:US
Practice Address - Phone:804-379-7855
Practice Address - Fax:804-379-2159
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHESTERFIELD DENTAL CENTER PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010061451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty