PEDIATRIC DENTAL CARE OF TIDEWATER PC (NPI# 1891915112) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1891915112 |
Entity Type | Organization |
Organization Name | PEDIATRIC DENTAL CARE OF TIDEWATER PC |
Practice Address |
5915 High Street West Portsmouth VA 23703 |
Mailing Address |
5915 High St W Portsmouth VA 23703-4505 |
Practice Telephone | 7574848262 |
Practice Fax Number | 7576383632 |
Mailing Telephone | 7574848262 |
Mailing Fax Number | 7576383632 |
Enumeration Date | 2007-04-27 |
Last Update Date | 2012-05-02 |
Authorized Official Name | MORGAN TREY WEIS (OWNER) |
Authorized Official Telephone | 7574848262 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
0401410496 | VA | Dental Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
ANTHEM | 249681 | 01 | |
UNITED CONCORDIA | 1702520 | 01 |
Street Address |
5915 HIGH STREET WEST |
City | PORTSMOUTH |
State | VA |
Zip Code | 23703 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1497905640 | Roopa S Murthy | Dentist | 5915 High Street West, Suite 100, Portsmouth, VA 23703 | 2008-09-24 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1174037444 | Kelly Foster | Massage Therapist | 3108 Tyre Neck Rd Ste D, Portsmouth, VA 23703 | 2017-11-25 |
1578072104 | Katherine Armstrong Wise | Behavior Technician | 3120 Verne Ave, Portsmouth, VA 23703 | 2017-09-27 |
1891223913 | Ashley Rebecca Anderson | Dentist | 5915 High Street W, Portsmouth, VA 23703 | 2017-06-02 |
1881126019 | Anas Elmahdi | Specialist | 5205 Sweetbriar C., 5205 Sweetbriar C., Portsmouth, VA 23703 | 2017-03-28 |
1578003554 | Elyse Buttery | Nurse Practitioner | Mast One 1040 University Blvd, Suite 200, Portsmouth, VA 23703 | 2017-02-24 |
1376948349 | Charles Douglas Knight | Military Health Care Provider | Uss Maryland Ssbn 738, Fpo, AA 23703 | 2014-11-03 |
1689929382 | Positive Connections, Inc | Community/Behavioral Health | 3823d Meherrin River Reach, Portsmouth, VA 23703 | 2012-07-18 |
1225319874 | Sanaz Namin | Pharmacist | 5601 High Street, Porstmouth, VA 23703 | 2011-09-08 |
1295029767 | Maggie Jackson | Dental Hygienist | 4000 Coast Guard Blvd., Portsmouth, VA 23703 | 2011-06-02 |
1679804892 | Amy Kathleenn Gaspar | Specialist/Technologist, Other | 4113 Pendleton Rd, Portsmouth, VA 23703 | 2010-01-28 |
Find all providers in zip 23703 |
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 |
---|---|---|---|---|
1851919989 | Lavoie & Associates | Dentist | 31 King Charles Dr Ste D, Portsmouth, RI 02871-1448 | 2020-07-06 |
1891223913 | Ashley Rebecca Anderson | Dentist | 5915 High Street W, Portsmouth, VA 23703 | 2017-06-02 |
1669636890 | Jb Martin Iv Dds PC | Dentist | 730 High St, Portsmouth, VA 23704-3426 | 2008-07-16 |
1184849598 | Dr. Keith Eveland | Dentist | 111 Bow Street, Portsmouth, NH 03801 | 2007-04-13 |
1235274812 | Keith Ware Eveland | Dentist | 111 Bow St, Portsmouth, NH 03801-3838 | 2007-02-21 |
1114093937 | Jb Martin Iv | Dentist | 446 Effingham St Fl 1, Portsmouth, VA 23704-3464 | 2006-11-24 |
1033192398 | Morgan Trey Weis | Dentist | 5915 High St W, Portsmouth, VA 23703-4505 | 2005-11-21 |
1477534857 | Viena Gerlaine Posada | Dentist | 1950 Lafayette Rd Ste 301, Portsmouth, NH 03801-8864 | 2005-11-10 |
1295960615 | Friendly Faces Pediactric Dentistry | Dentist | 446 Effingham St, 1st Floor, Portsmouth, VA 23704-3416 | 2009-05-29 |
1407081268 | Friendly Faces Pediatric Dentistry | Dentist | 446 Effingham St, 1st Floor, Portsmouth, VA 23704-3416 | 2009-05-22 |
Find all providers in PORTSMOUTH |
City | PORTSMOUTH |
Zip Code | 23703 |
Please comment or provide details below to improve the information on PEDIATRIC DENTAL CARE OF TIDEWATER PC.
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.