Organization
FAMILY DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DANA LANETTE MUNDY (PRACTICE ADMINISTRATOR)
(540) 898-8616
Entity
Organization
Contact information
Practice address
10620 COURTHOUSE ROAD, FREDERICKSBURG, VA 22407
(540) 898-8616
(540) 898-7755
Mailing address
10620 COURTHOUSE ROAD, FREDERICKSBURG, VA 22407
(540) 898-8616
(540) 898-7755
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401007440
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111828
BLUE CROSS BLUE SHIELD
VA
01
—
902653
UNITED CONCORIA
VA
Enumeration date
09/28/2006
Last updated
08/22/2020
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