Provider Demographics
NPI:1992260681
Name:PKS DENTISTRY PLLC
Entity type:Organization
Organization Name:PKS DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:STOVER-MEJIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-973-7744
Mailing Address - Street 1:1522 INSURANCE LN STE B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-7229
Mailing Address - Country:US
Mailing Address - Phone:434-973-7744
Mailing Address - Fax:434-975-0250
Practice Address - Street 1:1522 INSURANCE LN STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-7229
Practice Address - Country:US
Practice Address - Phone:434-973-7744
Practice Address - Fax:434-975-0250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental