Provider Demographics
NPI:1043372345
Name:MIDGETTE DENTISTRY RVA, PLLC
Entity type:Organization
Organization Name:MIDGETTE DENTISTRY RVA, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RCM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-568-5773
Mailing Address - Street 1:8133 FOREST HILL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-3254
Mailing Address - Country:US
Mailing Address - Phone:804-272-2010
Mailing Address - Fax:804-330-4703
Practice Address - Street 1:8133 FOREST HILL AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235
Practice Address - Country:US
Practice Address - Phone:804-272-2010
Practice Address - Fax:804-330-4703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010046341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA868458OtherUNITED CONCORDIA
VA180683OtherANTHEM BCBS WELLPOINT