Basic Information
| Provider Information | |||||||||
| NPI: | 1457425498 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOLCK | ||||||||
| FirstName: | VINITA | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4544 COLUMBUS ST | ||||||||
| Address2: | APT. 832 | ||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234626749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102737230 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4239 HOLLAND RD | ||||||||
| Address2: | SUITE 762-A | ||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234521941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574675665 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 11/24/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 0401411668 | VA | Y | Dental Providers | Dentist | General Practice |
No ID Information.