1215560370 NPI number — RED APPLE PEDIATRIC DENTAL TEAM

Table of content: (NPI 1215560370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215560370 NPI number — RED APPLE PEDIATRIC DENTAL TEAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RED APPLE PEDIATRIC DENTAL TEAM
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:
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:
1215560370
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1003 GARRISONVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STAFFORD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22556-1843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-318-5577
Provider Business Mailing Address Fax Number:
540-369-6250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1003 GARRISONVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STAFFORD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22556-1843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-318-5577
Provider Business Practice Location Address Fax Number:
540-369-6250
Provider Enumeration Date:
02/18/2020

Additional Information

Authorized Official

Authorized Official Last Name:
ASHBY
Authorized Official First Name:
SKYLAR
Authorized Official Middle Name:
Authorized Official Title or Position:
FRONT DESK
Authorized Official Telephone Number:
540-318-5577

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com