Provider Demographics
NPI:1568822872
Name:SHORT PUMP FAMILY DENTISTRY
Entity Type:Organization
Organization Name:SHORT PUMP FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YUN
Authorized Official - Middle Name:
Authorized Official - Last Name:TSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-833-3432
Mailing Address - Street 1:5209 WHEAT RIDGE PL
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5651
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 TOWNE CENTER WEST BLVD
Practice Address - Street 2:SUITE 709
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1196
Practice Address - Country:US
Practice Address - Phone:804-833-3432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014125021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty