1679653224 NPI number — DR. JOSEPH C DOBSON III D.D.S.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679653224 NPI number — DR. JOSEPH C DOBSON III D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOBSON
Provider First Name:
JOSEPH
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679653224
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 LYNNHAVEN PKWY
Provider Second Line Business Mailing Address:
SUUITE #100
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23456-1492
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-416-1400
Provider Business Mailing Address Fax Number:
757-416-9276

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 LYNNHAVEN PKWY
Provider Second Line Business Practice Location Address:
SUUITE #100
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23456-1492
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-416-1400
Provider Business Practice Location Address Fax Number:
757-416-9276
Provider Enumeration Date:
10/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  0401410058 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 816276 . This is a "UNITED CONCORDIA ID" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 019711 . This is a "ANTHEM ID" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".