Provider Demographics
NPI:1306314885
Name:ADRIAN M. LAXA, DDS, PC
Entity type:Organization
Organization Name:ADRIAN M. LAXA, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAXA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-497-0450
Mailing Address - Street 1:4540 PRINCESS ANNE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-7962
Mailing Address - Country:US
Mailing Address - Phone:757-497-0450
Mailing Address - Fax:757-497-6137
Practice Address - Street 1:4540 PRINCESS ANNE RD STE 101
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-7962
Practice Address - Country:US
Practice Address - Phone:757-497-0450
Practice Address - Fax:757-497-6137
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC DENTAL CARE PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty