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PEDIATRIC DENTISTRY OF VIRGINIA PLLC NPI 1295964955


NPI Information

NPI: 1295964955
Provider Name: PEDIATRIC DENTISTRY OF VIRGINIA, PLLC

Doing Business As: HANOVER PEDIATRIC DENTISTRY

Classification: Dentist - 1223P0221X
Entity Type: Organization

Specialization: Pediatric Dentistry

CLIA Number: 49D0948709

Address:
8203 CENTER PATH LANE
SUITE A
MECHANICSVILLE, VA
ZIP 23116
Phone: (804) 746-7382
Get Directions

PEDIATRIC DENTISTRY OF VIRGINIA, PLLC is a pediatric dentistry dentist in Mechanicsville, VA. The provider is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. PEDIATRIC DENTISTRY OF VIRGINIA, PLLC NPI is 1295964955. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As Hanover Pediatric Dentistry.

The provider's business location address is:

8203 CENTER PATH LANE
SUITE A
MECHANICSVILLE, VA
ZIP 23116
Phone: (804) 746-7382
Fax: (804) 746-3025

The provider's authorized official is Andrew D Zima .
The authorized official title is Pediatric Dentist and has the following contact phone number (804) 746-7382.

The CLIA number assigned to this NPI record is 49D0948709 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/2/2009 and was last updated on 10/11/2009.


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 Dentistry0401411085VIRGINIANo
21223P0221XDentistPediatric Dentistry0401412165VIRGINIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
19179294MEDICAIDVIRGINIA

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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