| Lifetime Dentistry At Short Pump | |
|
12244 W Broad St Henrico VA 23233-1062 | |
| (804) 360-8890 | |
| (804) 360-8894 |
| Full Name | Lifetime Dentistry At Short Pump |
|---|---|
| Speciality | Dentist |
| Location | 12244 W Broad St, Henrico, Virginia |
| Authorized Official Name and Position | All Credentialing (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2175402100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifetime Dentistry At Short Pump 12244 W Broad St Henrico VA 23233-1062 Ph: (804) 360-8890 | Lifetime Dentistry At Short Pump 12244 W Broad St Henrico VA 23233-1062 Ph: (804) 360-8890 |
| NPI Number | 1396012936 |
|---|---|
| Provider Enumeration Date | 11/28/2011 |
| Last Update Date | 10/28/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396012936 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 0401413582 (Virginia) | Primary |
| 122300000X | Dentist | 0401412223 (Virginia) | Secondary |
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
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