Organization
KEETON, GOKLI, LUBBE, BRIDGES-POQUIS & RADDIN,
Active
Other names
Pediatric Dentistry and Orthodontics of Virginia
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAROL ROPER (PRACTICE ADMINISTRATOR)
(804) 739-0963
Entity
Organization
Contact information
Practice address
13841 HULL STREET RD, SUITE 4, MIDLOTHIAN, VA 23112-2056
(804) 739-0963
(804) 739-0965
Mailing address
13841 HULL STREET RD, SUITE 4, MIDLOTHIAN, VA 23112-2056
(804) 739-0963
(804) 739-0965
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
0401004876
VA
1223P0221X
Pediatric Dentistry
0401007234
VA
1223P0221X
Pediatric Dentistry
0401410240
VA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
0401004475
VA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
0401410225
VA
Other
Enumeration date
07/18/2006
Last updated
02/11/2011
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