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Individual

DR. STEPHEN C BOOTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.D.S.

Contact information

Practice address
5954 HARBOUR PARK DR, MIDLOTHIAN, VA 23112-2163
(804) 739-1600
(804) 739-9035
Mailing address
5954 HARBOUR PARK DR, MIDLOTHIAN, VA 23112-2163
(804) 739-1600
(804) 739-9035

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401411024
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
11024
DELTA DENTAL PROVIDER NO.
VA
01
182419
ANTHEM PROVIDER NO.
VA
05
9179964
VA
Enumeration date
10/03/2006
Last updated
06/29/2014
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