Provider Demographics
NPI:1699912816
Name:POWHATAN GENTLE DENTISTRY
Entity type:Organization
Organization Name:POWHATAN GENTLE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:COURTNEY
Authorized Official - Last Name:HYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-598-8951
Mailing Address - Street 1:2105 ACADEMY ROAD
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139
Mailing Address - Country:US
Mailing Address - Phone:804-598-8951
Mailing Address - Fax:804-598-7527
Practice Address - Street 1:2105 ACADEMY ROAD
Practice Address - Street 2:SUITE J
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139
Practice Address - Country:US
Practice Address - Phone:804-598-8951
Practice Address - Fax:804-598-7527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VABH5972383302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization