Organization
CHARLOTTESVILLE ORAL SURGERY AND DENTAL IMPLANT CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARLOS IBANEZ DDS (PRESIDENT)
(434) 823-7711
Entity
Organization
Contact information
Practice address
1415 ROLKIN CT STE 101, CHARLOTTESVILLE, VA 22911-3643
(434) 295-0911
Mailing address
1415 ROLKIN CT STE 101, CHARLOTTESVILLE, VA 22911-3643
(434) 295-0911
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
0438000261
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2105438
—
NY
Enumeration date
01/20/2009
Last updated
11/14/2018
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