Organization
DENTAL PROFESSIONALS OF VIRGINIA, P.C
Active
Parent organization
DENTAL PROFESSIONALS OF VIRGINIA, P.C
Other names
Lake Ridge Dental Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTAL PROFESSIONALS OF VIRGINIA, P.C
Authorized official
HILLARY THULL (CREDENTIALING COORDINATOR)
(217) 540-8946
Entity
Organization
Contact information
Practice address
13625 OFFICE PL STE 102, WOODBRIDGE, VA 22192-4270
(703) 670-7071
Mailing address
13625 OFFICE PL STE 102, WOODBRIDGE, VA 22192-4270
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/04/2022
Last updated
04/04/2022
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