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Organization
CHARLOTTESVILLE ORAL SURGERY AND DENTAL IMPLANT CENTER, LLC
Active
Organization
CHARLOTTESVILLE ORAL SURGERY AND DENTAL IMPLANT CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARLOS IBANEZ DDS (PRESIDENT)
(434) 823-7711
Entity
Organization
Contact information
Practice address
1415 ROLKIN CT STE 101, CHARLOTTESVILLE, VA 22911-3643
(434) 295-0911
Mailing address
1415 ROLKIN CT STE 101, CHARLOTTESVILLE, VA 22911-3643
(434) 295-0911
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
0438000261
VA
Other
Enumeration date
01/20/2009
Last updated
11/14/2018
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