# PEDIATRIC DENTISTRY & ORTHODONTICS OF VA, PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CENTRAL VIRGINIA DENTAL CARE, P.L.C.-PEDIATRIC DENTISTRY & ORTHODONTIC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1124579396
- **Legal business name:** CENTRAL VIRGINIA DENTAL CARE, P.L.C.-PEDIATRIC DENTISTRY & ORTHODONTIC
- **Authorized official:** STEVEN R. LUBBE D.M.D. (VICE PRESIDENT)
- **Authorized official phone:** (804) 739-0963

## Contact information

- **Practice address:** 13463 HULL STREET RD., MIDLOTHIAN, VA 23112-2103
- **Practice address phone:** (804) 739-0963
- **Practice address fax:** (804) 739-0965
- **Mailing address:** 13463 HULL STREET RD., MIDLOTHIAN, VA 23112-2103
- **Mailing address phone:** (804) 739-0963
- **Mailing address fax:** (804) 739-0965

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 1223P0221X | Pediatric Dentistry | — | NULL | — |
| 1223P0221X | Pediatric Dentistry | — | — | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | NULL | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | — | — |

## Other

- **Enumeration date:** 10/21/2016
- **Last updated:** 12/12/2023