PEDIATRIC DENTAL CARE OF VIRGINIA (NPI# 1366654808) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366654808 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC DENTAL CARE OF VIRGINIA |
| Practice Address |
5126 King's Mountain Road Collinsville VA 24078 |
| Practice Telephone | 2766472033 |
| Practice Fax Number | 2766472034 |
| Mailing Telephone | 2766472033 |
| Mailing Fax Number | 2766472034 |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | GABRIEL MALCHIJAH BROWN (PRESIDENT) |
| Authorized Official Telephone | 5402932289 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
0401410219 | VA | Dental Providers |
| Street Address |
5126 KING'S MOUNTAIN ROAD |
| City | COLLINSVILLE |
| State | VA |
| Zip Code | 24078 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720603434 | Allyson C Dillard | Non-emergency Medical Transport (VAN) | 1998 Virginia Ave Suite A, Collinsville, VA 24078 | 2020-06-09 |
| 1114054699 | John William Rhoday | Dentist | 4721 King's Mountain Road, Collinsville, VA 24078 | 2007-02-28 |
| 1205841939 | Denise J Unterbrink | Dentist | 2200 Daniels Creek Rd, Collinsville, VA 24078 | 2006-07-30 |
| 1861414062 | Stephen P Kieselbach | Chiropractor | 3408-1 Virginia Ave., Collinsville, VA 24078 | 2006-07-24 |
| 1114254877 | Julie Brown | Optometrist | 4244 Virginia Ave, Collinsville, VA 24078 | 2009-11-17 |
| 1548491293 | Shannon Marie Zollinger | Optometrist | 4244 Virginia Ave, Collinsville, VA 24078 | 2009-07-29 |
| 1871828756 | Family Preservation Services, Inc | Community/Behavioral Health | 15 Primary School Rd, Collinsville, VA 24078-1104 | 2009-10-09 |
| 1811546831 | Renita Mayhan | Licensed Practical Nurse | 200 Terrace Garden Dr, Collinsville, VA 24078-1134 | 2019-09-11 |
| 1720169378 | Lincare Inc. | Durable Medical Equipment & Medical Supplies | 4811 Kings Mountain Rd, Collinsville, VA 24078-1273 | 2006-10-18 |
| 1679925614 | Jaime Woodall | Dentist | 4721 Kings Mountain Rd, Collinsville, VA 24078-1274 | 2016-07-01 |
| Find all providers in zip 24078 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| 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. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639210768 | Kenneth Scott Kollmann | Dentist | 90 Crestmoor St, Spring Meadow Professional Park, Collinsville, IL 62234-4951 | 2007-02-10 |
| 1295366896 | Collinsville Pediatric Dentistry Pllc | Dentist | 90 Crestmoor St, Collinsville, IL 62234-4951 | 2020-02-01 |
| 1588792980 | Kenneth S. Kollmann, D.m.d.,p.c. | Dentist | 90 Crestmoor St, Spring Meadow Professional Park, Collinsville, IL 62234-4951 | 2007-02-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750998878 | Nadgie Ortiz Diaz Dmd Pllc | Dentist | 24560 Southpoint Dr Ste 240, Aldie, VA 20105-3505 | 2020-09-24 |
| 1154948289 | Cardinal Pediatric Dentistry Pllc | Dentist | 11551 Nuckols Rd Ste H, Glen Allen, VA 23059-5565 | 2020-07-06 |
| 1043842214 | Funpedopark LLC | Dentist | 1009 Centerbrooke Ln Ste 210, Suffolk, VA 23434-8664 | 2020-02-06 |
| 1861023251 | Bitty Bites Pediatric Dentistry Inc. | Dentist | 11600 Busy St Ste 101, North Chesterfield, VA 23236-4066 | 2020-02-04 |
| 1952963746 | Oula Kowatli | Dentist | 8255 Trailwood Ct, Vienna, VA 22182 | 2019-07-02 |
| 1770149742 | Noeen Arshad | Dentist | 129 University Blvd Ste A, Harrisonburg, VA 22801-3751 | 2019-05-15 |
| 1609353499 | Prachi Chandalia | Dentist | 609 E Monroe Ave, Alexandria, VA 22301-3020 | 2018-07-24 |
| 1255817730 | Fusion Dental | Dentist | 1401 Chain Bridge Rd, Mc Lean, VA 22101-6026 | 2018-07-17 |
| 1952897050 | Danielle Miller | Dentist | 11934 W Broad St Ste 120, Henrico, VA 23233-1100 | 2018-07-02 |
| 1063929057 | Anna Maria Boggs, Dmd, PC | Dentist | 1947 A Medical Ave, Harrisonburg, VA 22801 | 2017-12-29 |
| Find all providers with the same taxonomy | ||||
| City | COLLINSVILLE |
| Zip Code | 24078 |
Please comment or provide details below to improve the information on PEDIATRIC DENTAL CARE OF VIRGINIA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.