| Lake Plaza Dental Pc | |
|
36101 Goodwin Dr Locust Grove VA 22508-2029 | |
| (540) 226-6744 | |
| Not Available |
| Full Name | Lake Plaza Dental Pc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 36101 Goodwin Dr, Locust Grove, Virginia |
| Authorized Official Name and Position | Edwin Arthur Torrey (PRESIDENT/OWNER) |
| Authorized Official Contact | 5404550107 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Plaza Dental Pc 11315 Hidden Cv Spotsylvania VA 22551-8919 Ph: (540) 455-0107 | Lake Plaza Dental Pc 36101 Goodwin Dr Locust Grove VA 22508-2029 Ph: (540) 226-6744 |
| NPI Number | 1386147668 |
|---|---|
| Provider Enumeration Date | 03/13/2018 |
| Last Update Date | 03/13/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386147668 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 0401007015 (Virginia) | Primary |