Provider Demographics
NPI:1578799383
Name:VIRGINIA SURGICAL ARTS, LLC
Entity Type:Organization
Organization Name:VIRGINIA SURGICAL ARTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:SERGIO
Authorized Official - Last Name:VENDETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DMD
Authorized Official - Phone:757-430-7690
Mailing Address - Street 1:1240 PERIMETER PKWY STE 401
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-5698
Mailing Address - Country:US
Mailing Address - Phone:757-430-7690
Mailing Address - Fax:757-430-7693
Practice Address - Street 1:1240 PERIMETER PKWY STE 401
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-5698
Practice Address - Country:US
Practice Address - Phone:757-430-7690
Practice Address - Fax:757-430-7693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012363221223P0106X
VA04014112751223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty