Provider Demographics
NPI:1497957286
Name:VIRGINIA ORTHODONTIC SPECIALIST
Entity Type:Organization
Organization Name:VIRGINIA ORTHODONTIC SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:WAITKUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:757-826-8511
Mailing Address - Street 1:2101 EXECUTIVE DR STE 5E
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2415
Mailing Address - Country:US
Mailing Address - Phone:757-826-8511
Mailing Address - Fax:
Practice Address - Street 1:2101 EXECUTIVE DR STE 5E
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2415
Practice Address - Country:US
Practice Address - Phone:757-826-8511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010040321223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty