| Dedicated Dental Pllc | |
|
11 Hope Rd Ste 201 Stafford VA 22554-7287 | |
| (540) 899-1777 | |
| Not Available |
| Full Name | Dedicated Dental Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 11 Hope Rd Ste 201, Stafford, Virginia |
| Authorized Official Name and Position | Carter M Waller (PART OWNER DENTIST) |
| Authorized Official Contact | 5619014700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dedicated Dental Pllc 11 Hope Rd Ste 201 Stafford VA 22554-7287 Ph: (540) 318-8691 | Dedicated Dental Pllc 11 Hope Rd Ste 201 Stafford VA 22554-7287 Ph: (540) 899-1777 |
| NPI Number | 1700469103 |
|---|---|
| Provider Enumeration Date | 05/03/2021 |
| Last Update Date | 05/03/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700469103 | NPI | - | NPPES |
| 0401413995 | Other | VA | DENTAL LICENSE NUMBER |
| 0401416501 | Other | VA | DENTAL LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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