| Boydton Dental Center | |
|
1329 Jefferson Street Boydton VA 23917 | |
| (434) 738-0729 | |
| (434) 738-6982 |
| Full Name | Boydton Dental Center |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1329 Jefferson Street, Boydton, Virginia |
| Authorized Official Name and Position | Angela N Miller (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4347386102 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Boydton Dental Center Po Box 540 Boydton VA 23917-0540 Ph: (434) 738-6102 | Boydton Dental Center 1329 Jefferson Street Boydton VA 23917 Ph: (434) 738-0729 |
| NPI Number | 1114184546 |
|---|---|
| Provider Enumeration Date | 05/22/2008 |
| Last Update Date | 07/24/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114184546 | NPI | - | NPPES |
| 007691092 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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