Provider Demographics
NPI:1356833404
Name:ATLANTIC DENTAL CARE PLC
Entity Type:Organization
Organization Name:ATLANTIC DENTAL CARE PLC
Other - Org Name:PENINSULA FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:HEATH
Authorized Official - Last Name:CASH
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-874-8612
Mailing Address - Street 1:606 DENBIGH BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608
Mailing Address - Country:US
Mailing Address - Phone:757-874-8612
Mailing Address - Fax:
Practice Address - Street 1:606 DENBIGH BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608
Practice Address - Country:US
Practice Address - Phone:757-874-8612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC DENTAL CARE PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411255122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty