1437534708 NPI number — COMMONWEALTH DENTAL ANESTHESIA ASSOCIATES PC

Table of content: (NPI 1437534708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437534708 NPI number — COMMONWEALTH DENTAL ANESTHESIA ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMONWEALTH DENTAL ANESTHESIA ASSOCIATES PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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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:
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Provider Other Name Prefix Text:
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NPI Number Information

NPI Number:
1437534708
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 HAXALL PT
Provider Second Line Business Mailing Address:
UNIT 1004
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23219-3941
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 HAXALL PT
Provider Second Line Business Practice Location Address:
UNIT 1004
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23219-3941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-242-5446
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BALLENTINE
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
Authorized Official Title or Position:
DENTIST ANESTHESIOLOGIST
Authorized Official Telephone Number:
646-789-3860

Provider Taxonomy Codes

  • Taxonomy code: 1223D0004X , 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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