| Virginia Oral & Facial Surgery | |
|
130 Towne Center West Boulevard Henrico VA 23233-2323 | |
| (804) 270-5028 | |
| (804) 747-3599 |
| Full Name | Virginia Oral & Facial Surgery |
|---|---|
| Speciality | Oral & Maxillofacial Surgery |
| Location | 130 Towne Center West Boulevard, Henrico, Virginia |
| Authorized Official Name and Position | Tina Marie Pitkin Rose (PROJECT COORDINATOR) |
| Authorized Official Contact | 8045320002 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Virginia Oral & Facial Surgery 11545 A Nuckols Road Glen Allen VA 23059-5666 Ph: (804) 673-8061 | Virginia Oral & Facial Surgery 130 Towne Center West Boulevard Henrico VA 23233-2323 Ph: (804) 270-5028 |
| NPI Number | 1952356487 |
|---|---|
| Provider Enumeration Date | 05/23/2006 |
| Last Update Date | 01/29/2024 |
| Medicare PECOS PAC ID | 7719973247 |
|---|---|
| Medicare Enrollment ID | O20040421001133 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952356487 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Secondary |
| 204E00000X | Oral & Maxillofacial Surgery | (* (Not Available)) | Primary |
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