Provider Demographics
NPI:1366735235
Name:V CARE DENTAL
Entity type:Organization
Organization Name:V CARE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-815-0007
Mailing Address - Street 1:14631 LEE HWY
Mailing Address - Street 2:117
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-5824
Mailing Address - Country:US
Mailing Address - Phone:703-815-0007
Mailing Address - Fax:703-815-0008
Practice Address - Street 1:14631 LEE HWY
Practice Address - Street 2:117
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-5824
Practice Address - Country:US
Practice Address - Phone:703-815-0007
Practice Address - Fax:703-815-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014120061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9219161Medicaid