Organization
COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Active
Other names
Stafford Dental
Organization subpart
No
Provider details
NPI number
Authorized official
JANE KRAKOWSKY (BUSINESS MANAGER)
(540) 899-4797
Entity
Organization
Contact information
Practice address
1739 JEFFERSON DAVIS HWY, STAFFORD, VA 22554-7213
(540) 288-2579
(540) 288-3796
Mailing address
608 JACKSON ST, FREDERICKSBURG, VA 22401-5719
(540) 899-4797
(540) 899-4599
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104852
DORAL
VA
01
—
144853
ANTHEM-MILLER
VA
Enumeration date
08/11/2006
Last updated
08/25/2008
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