Provider Demographics
NPI:1447416276
Name:VIRGINIA DENTAL & ANESTHESIA ASSOCIATES
Entity Type:Organization
Organization Name:VIRGINIA DENTAL & ANESTHESIA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:H
Authorized Official - Middle Name:L
Authorized Official - Last Name:POPE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-786-0696
Mailing Address - Street 1:1420 CENTRAL PARK BLVD
Mailing Address - Street 2:#201
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4932
Mailing Address - Country:US
Mailing Address - Phone:540-786-0696
Mailing Address - Fax:540-785-1340
Practice Address - Street 1:1420 CENTRAL PARK BLVD
Practice Address - Street 2:#201
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4932
Practice Address - Country:US
Practice Address - Phone:540-786-0696
Practice Address - Fax:540-785-1340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0069411223G0001X, 1223X0400X
VA0075961223G0001X
VA040010077101223P0221X
VA0078511223P0221X
VA80005731223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty