Provider Demographics
NPI:1093591604
Name:CUSP UNTETHERED, PLLC
Entity Type:Organization
Organization Name:CUSP UNTETHERED, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZANETA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-904-4347
Mailing Address - Street 1:4440 SHORE DR STE 100B
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-3046
Mailing Address - Country:US
Mailing Address - Phone:757-904-4347
Mailing Address - Fax:
Practice Address - Street 1:4440 SHORE DR STE 100B
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-3046
Practice Address - Country:US
Practice Address - Phone:757-904-4347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty