Organization
COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Active
Other names
Caroline Dental
Organization subpart
No
Provider details
NPI number
Authorized official
JANE D KRAKOWSKY (BUSINESS MANAGER)
(540) 899-4797
Entity
Organization
Contact information
Practice address
17202 RICHMOND TURNPIKE, MILFORD, VA 22514
(804) 633-5465
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
—
104671
DORAL
VA
01
—
142948
ANTHEM-COLE
VA
01
—
144844
ANTHEM-MILLER
VA
Enumeration date
09/11/2006
Last updated
08/25/2008
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