# COMMONWEALTH PEDIATRIC DENTISTRY, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CENTRAL VIRGINIA DENTAL CARE PLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1982140620
- **Legal business name:** CENTRAL VIRGINIA DENTAL CARE PLC
- **Authorized official:** LAURI HENDERSON (ADMINISTRATIVE ASSISTANT)
- **Authorized official phone:** (804) 363-4283

## Contact information

- **Practice address:** 6661 LAKE HARBOUR DR, MIDLOTHIAN, VA 23112-2082
- **Practice address phone:** (804) 363-4283
- **Mailing address:** 6661 LAKE HARBOUR DR, MIDLOTHIAN, VA 23112-2082

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 01/18/2017
- **Last updated:** 01/18/2017