Provider Demographics
NPI:1437534708
Name:COMMONWEALTH DENTAL ANESTHESIA ASSOCIATES PC
Entity Type:Organization
Organization Name:COMMONWEALTH DENTAL ANESTHESIA ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST ANESTHESIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-789-3860
Mailing Address - Street 1:1101 HAXALL PT
Mailing Address - Street 2:UNIT 1004
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-3941
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1101 HAXALL PT
Practice Address - Street 2:UNIT 1004
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-3941
Practice Address - Country:US
Practice Address - Phone:434-242-5446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDentist AnesthesiologistGroup - Single Specialty