Provider Demographics
NPI:1174972590
Name:ADMIRE DENTAL CARE PLLC
Entity type:Organization
Organization Name:ADMIRE DENTAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:THEOMAT
Authorized Official - Last Name:EUGENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-316-5512
Mailing Address - Street 1:13737 LYNN ST
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-2125
Mailing Address - Country:US
Mailing Address - Phone:571-316-5512
Mailing Address - Fax:
Practice Address - Street 1:14086 JEFFERSON DAVIS HIGHWAY
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-2125
Practice Address - Country:US
Practice Address - Phone:571-316-5512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413446122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty