| King George Dental Llc | |
|
15521 Real Estate Ave Ste 200 King George VA 22485-5327 | |
| (540) 663-3139 | |
| Not Available |
| Full Name | King George Dental Llc |
|---|---|
| Speciality | Dentist |
| Location | 15521 Real Estate Ave, King George, Virginia |
| Authorized Official Name and Position | Philip James Spory (PRESIDENT) |
| Authorized Official Contact | 5406633139 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| King George Dental Llc 15521 Real Estate Ave Ste 200 King George VA 22485-5327 Ph: (540) 663-3139 | King George Dental Llc 15521 Real Estate Ave Ste 200 King George VA 22485-5327 Ph: (540) 663-3139 |
| NPI Number | 1538412424 |
|---|---|
| Provider Enumeration Date | 10/17/2012 |
| Last Update Date | 12/06/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538412424 | NPI | - | NPPES |
| 5057872 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 0401413422 (Virginia) | Primary |
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