1144274382 NPI number — COMMONWEALTH ORAL & FACIAL SURGERY, PC

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 1144274382 NPI number — COMMONWEALTH ORAL & FACIAL SURGERY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMONWEALTH ORAL & FACIAL SURGERY, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1144274382
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 71930
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23255-1930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-354-1600
Provider Business Mailing Address Fax Number:
804-354-1607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8503 PATTERSON AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23229-6442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-354-1600
Provider Business Practice Location Address Fax Number:
804-354-1607
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KENNON
Authorized Official First Name:
GWEN
Authorized Official Middle Name:
EVA
Authorized Official Title or Position:
SENIOR BILLING SPECIALIST
Authorized Official Telephone Number:
804-354-1602

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  0135583-3 , 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)





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