Provider Demographics
NPI:1912459215
Name:CENTRAL VIRGINIA DENTAL CARE PLC
Entity Type:Organization
Organization Name:CENTRAL VIRGINIA DENTAL CARE PLC
Other - Org Name:SPARKLE PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PEDIATRIC DENTAL SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:CHRISTEL
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:804-746-7382
Mailing Address - Street 1:8203 CENTER PATH LANE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-4060
Mailing Address - Country:US
Mailing Address - Phone:804-746-7382
Mailing Address - Fax:804-368-1448
Practice Address - Street 1:8203 CENTER PATH LANE
Practice Address - Street 2:SUITE A
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-4060
Practice Address - Country:US
Practice Address - Phone:804-746-7382
Practice Address - Fax:804-368-1448
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL VIRGINIA DENTAL CARE PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-03
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty