Provider Demographics
NPI:1881299162
Name:MIDLOTHIAN DENTAL ARTS
Entity type:Organization
Organization Name:MIDLOTHIAN DENTAL ARTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:W
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-379-9177
Mailing Address - Street 1:151 LE GORDON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-4333
Mailing Address - Country:US
Mailing Address - Phone:804-379-9177
Mailing Address - Fax:804-379-9196
Practice Address - Street 1:151 LE GORDON DR STE 100
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-4333
Practice Address - Country:US
Practice Address - Phone:804-379-9177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL VIRGINIA DENTAL CARE PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-03
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty