Provider Demographics
NPI:1568232171
Name:ATLANTIC DENTAL CARE, PLC
Entity Type:Organization
Organization Name:ATLANTIC DENTAL CARE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DORFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-481-3699
Mailing Address - Street 1:2142 GREAT NECK SQ
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2202
Mailing Address - Country:US
Mailing Address - Phone:757-481-3699
Mailing Address - Fax:757-481-1494
Practice Address - Street 1:2142 GREAT NECK SQ
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2202
Practice Address - Country:US
Practice Address - Phone:757-481-3699
Practice Address - Fax:757-481-1494
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC DENTAL CARE, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0401416092OtherVA DENTAL LICENSE NUMBER
VA0401412884OtherVA DENTAL LICENSE NUMBER