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PEDIATRIC DENTISTRY & ORTHODONTICS OF VA PC NPI 1124579396


NPI Information

NPI: 1124579396
Provider Name: PEDIATRIC DENTISTRY & ORTHODONTICS OF VA, PC
Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

CLIA Number: 49D0687043

Address:
13463 HULL STREET RD.
MIDLOTHIAN, VA
ZIP 23112
Phone: (804) 739-0963
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PEDIATRIC DENTISTRY & ORTHODONTICS OF VA, PC is a general practice dentist in Midlothian, VA. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. PEDIATRIC DENTISTRY & ORTHODONTICS OF VA, PC NPI is 1124579396. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

13463 HULL STREET RD.
MIDLOTHIAN, VA
ZIP 23112-103
Phone: (804) 739-0963
Fax: (804) 739-0965

The provider's authorized official is Steven R. Lubbe .
The authorized official title is Vice President and has the following contact phone number (804) 739-0963.

The CLIA number assigned to this NPI record is 49D0687043 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/21/2016 and was last updated on 12/12/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223P0221XDentistPediatric DentistryNo
21223X0400XDentistOrthodontics and Dentofacial OrthopedicsNo
31223G0001XDentistGeneral PracticeYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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