Provider Demographics
NPI:1265860928
Name:DYNAMIC DENTAL HEALTH ASSOCIATES OF VIRGINIA,PC
Entity Type:Organization
Organization Name:DYNAMIC DENTAL HEALTH ASSOCIATES OF VIRGINIA,PC
Other - Org Name:CROSS ROAD DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHIAPARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-800-8040
Mailing Address - Street 1:136 4TH ST N STE 201
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3889
Mailing Address - Country:US
Mailing Address - Phone:727-800-8026
Mailing Address - Fax:727-304-3164
Practice Address - Street 1:4107 PORTSMOUTH BLVD STE 107
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-2140
Practice Address - Country:US
Practice Address - Phone:757-488-1421
Practice Address - Fax:727-488-7333
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DYNAMIC DENTAL HEALTH ASSOCIATES OF VIRGINIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-16
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA700145001Medicaid