Organization
DEDICATED DENTAL PLLC
Active
Other names
Dedicated Dental, Dedicated Dental LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARTER M WALLER DMD (PART OWNER DENTIST)
(561) 901-4700
Entity
Organization
Contact information
Practice address
11 HOPE RD STE 201, STAFFORD, VA 22554-7287
(540) 899-1777
Mailing address
11 HOPE RD STE 201, STAFFORD, VA 22554-7287
(540) 318-8691
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0401413995
DENTAL LICENSE NUMBER
VA
01
—
0401416501
DENTAL LICENSE NUMBER
VA
Enumeration date
05/03/2021
Last updated
05/03/2021
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