Provider Demographics
NPI:1073186656
Name:KATDEL LLC
Entity Type:Organization
Organization Name:KATDEL LLC
Other - Org Name:ADVANCED SEDATION DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-769-7155
Mailing Address - Street 1:200 BATTLEFIELD BLVD N STE 4
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3975
Mailing Address - Country:US
Mailing Address - Phone:757-769-7155
Mailing Address - Fax:
Practice Address - Street 1:200 BATTLEFIELD BLVD N STE 4
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3975
Practice Address - Country:US
Practice Address - Phone:757-769-7155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223D0004XDental ProvidersDentistDentist AnesthesiologistGroup - Multi-Specialty