Provider Demographics
NPI:1225490246
Name:CULPEPER KIDS DENTISTRY, PLLC
Entity Type:Organization
Organization Name:CULPEPER KIDS DENTISTRY, PLLC
Other - Org Name:CULPEPER KIDS DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:CASTASUS
Authorized Official - Last Name:AMANTE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:206-427-2977
Mailing Address - Street 1:18474 CROSSROAD PKWY
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-4112
Mailing Address - Country:US
Mailing Address - Phone:540-445-0271
Mailing Address - Fax:
Practice Address - Street 1:18474 CROSSROAD PKWY
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-4112
Practice Address - Country:US
Practice Address - Phone:540-445-0271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413425261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental