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43170 Southern Walk Plz Suite 116 Broadlands VA 20148-4464 | |
(703) 957-7066 | |
Not Available |
Full Name | |
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Speciality | Dentist - General Practice |
Location | 43170 Southern Walk Plz, Broadlands, Virginia |
Authorized Official Name and Position | Lindsay Bearden (INSURANE/CREDENTIALING) |
Authorized Official Contact | 2175405100 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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43170 Southern Walk Plz Suite 116 Broadlands VA 20148-4464 Ph: (703) 957-7066 | 43170 Southern Walk Plz Suite 116 Broadlands VA 20148-4464 Ph: (703) 957-7066 |
NPI Number | 1104253186 |
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Provider Enumeration Date | 10/04/2013 |
Last Update Date | 01/11/2014 |
Identifier | Type | State | Issuer |
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1104253186 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |