Provider Demographics
NPI:1235475286
Name:CENTER FOR RESTORATIVE, COSMETIC, AND IMPLANT DENTISTRY, PC
Entity Type:Organization
Organization Name:CENTER FOR RESTORATIVE, COSMETIC, AND IMPLANT DENTISTRY, PC
Other - Org Name:A DIVISION OF ATLANTIC DENTAL CARE, PLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:757-482-2876
Mailing Address - Street 1:825 BATTLEFIELD BLVD S
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-6607
Mailing Address - Country:US
Mailing Address - Phone:757-482-2876
Mailing Address - Fax:757-546-0235
Practice Address - Street 1:825 BATTLEFIELD BLVD S
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-6607
Practice Address - Country:US
Practice Address - Phone:757-482-2876
Practice Address - Fax:757-546-0235
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC DENTAL CARE, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412179122300000X
VA0401006003122300000X
VA0401411399122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty