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Organization

DENTAL PROFESSIONALS OF VIRGINIA, P.C

Active
Parent organization
DENTAL PROFESSIONALS OF VIRGINIA, P.C
Other names
Little Bull Run Dental
Organization subpart
Yes

Provider details

NPI number
Legal business name
DENTAL PROFESSIONALS OF VIRGINIA, P.C
Authorized official
KENDRA WALKER (CREDENTIALING SUPERVISOR)
(217) 540-8312
Entity
Organization

Contact information

Practice address
13801 HEATHCOTE BLVD, STE 100, GAINESVILLE, VA 20155
(571) 222-6042
Mailing address
13801 HEATHCOTE BLVD, STE 100, GAINESVILLE, VA 20155

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary

Other

Enumeration date
06/19/2017
Last updated
06/19/2017
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