Provider Demographics
NPI:1871882910
Name:DENTAL CARE PC
Entity type:Organization
Organization Name:DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-435-3008
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:283 MAIN STREET
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-0730
Mailing Address - Country:US
Mailing Address - Phone:804-435-3008
Mailing Address - Fax:804-435-9239
Practice Address - Street 1:283 N MAIN ST
Practice Address - Street 2:283 MAIN STREET
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482-9997
Practice Address - Country:US
Practice Address - Phone:804-435-3008
Practice Address - Fax:804-435-9239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005734261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental