Provider Demographics
NPI: | 1497443436 |
---|---|
Name: | VIRGINIA OROFACIAL PAIN AND SLEEP CENTER |
Entity Type: | Organization |
Organization Name: | VIRGINIA OROFACIAL PAIN AND SLEEP CENTER |
Other - Org Name: | VIRGINIA OROFACIAL PAIN & SLEEP CENTER |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | KRISHNA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GOPISETTY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 804-335-0599 |
Mailing Address - Street 1: | 5352 TWIN HICKORY RD |
Mailing Address - Street 2: | |
Mailing Address - City: | GLEN ALLEN |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 23059-5682 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 408-306-6556 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 5352 TWIN HICKORY RD |
Practice Address - Street 2: | |
Practice Address - City: | GLEN ALLEN |
Practice Address - State: | VA |
Practice Address - Zip Code: | 23059-5682 |
Practice Address - Country: | US |
Practice Address - Phone: | 408-306-6556 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-04-27 |
Last Update Date: | 2023-04-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Multi-Specialty |