| Charlottesville Oral Surgery And Dental Implant Center, Llc | |
|
1415 Rolkin Ct Ste 101 Charlottesville VA 22911-3643 | |
| (434) 295-0911 | |
| Not Available |
| Full Name | Charlottesville Oral Surgery And Dental Implant Center, Llc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 1415 Rolkin Ct Ste 101, Charlottesville, Virginia |
| Authorized Official Name and Position | Carlos Ibanez (PRESIDENT) |
| Authorized Official Contact | 4348237711 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Charlottesville Oral Surgery And Dental Implant Center, Llc 1415 Rolkin Ct Ste 101 Charlottesville VA 22911-3643 Ph: (434) 295-0911 | Charlottesville Oral Surgery And Dental Implant Center, Llc 1415 Rolkin Ct Ste 101 Charlottesville VA 22911-3643 Ph: (434) 295-0911 |
| NPI Number | 1972740454 |
|---|---|
| Provider Enumeration Date | 01/20/2009 |
| Last Update Date | 11/14/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972740454 | NPI | - | NPPES |
| 2105438 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 0438000261 (Virginia) | Primary |
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