Provider Demographics
NPI:1376840066
Name:CENTER FOR RESTORATIVE, COSMETIC, & IMPLANT DENTISTRY
Entity Type:Organization
Organization Name:CENTER FOR RESTORATIVE, COSMETIC, & IMPLANT DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:EGELAND-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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental