Provider Demographics
NPI:1376948794
Name:JUST 4 KIDS PEDIATRIC DENTISTRY AND SEDATION
Entity Type:Organization
Organization Name:JUST 4 KIDS PEDIATRIC DENTISTRY AND SEDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:O
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:804-562-2667
Mailing Address - Street 1:4301 W HUNDRED RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1959
Mailing Address - Country:US
Mailing Address - Phone:804-318-1623
Mailing Address - Fax:804-454-1786
Practice Address - Street 1:4301 W HUNDRED RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1959
Practice Address - Country:US
Practice Address - Phone:804-318-1623
Practice Address - Fax:804-454-1786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty