Provider Demographics
NPI:1114079480
Name:SHORT PUMPS DENTAL
Entity Type:Organization
Organization Name:SHORT PUMPS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:HAUEIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:804-747-0116
Mailing Address - Street 1:3811 WESTERRE PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1329
Mailing Address - Country:US
Mailing Address - Phone:804-747-0116
Mailing Address - Fax:804-747-6881
Practice Address - Street 1:3811 WESTERRE PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-1329
Practice Address - Country:US
Practice Address - Phone:804-747-0116
Practice Address - Fax:804-747-6881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010071591223G0001X
VA04010085631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty