Provider Demographics
NPI:1518418144
Name:JERYL A ABBOTT DDS PC
Entity Type:Organization
Organization Name:JERYL A ABBOTT DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABB0TT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-379-9177
Mailing Address - Street 1:1215 HYDE LN
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23229-6064
Mailing Address - Country:US
Mailing Address - Phone:804-387-6340
Mailing Address - Fax:804-379-9196
Practice Address - Street 1:151 LE GORDON DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-4333
Practice Address - Country:US
Practice Address - Phone:804-379-9177
Practice Address - Fax:804-379-9196
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL VIRGINIA DENTAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty