Provider Demographics
NPI:1598043739
Name:DENTAL ANESTHESIA SERVICES, LLC331
Entity Type:Organization
Organization Name:DENTAL ANESTHESIA SERVICES, LLC331
Other - Org Name:ADVANCED SEDATION DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FUTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-769-7155
Mailing Address - Street 1:616 VIRGINIA BEACH BLVD
Mailing Address - Street 2:#102
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451
Mailing Address - Country:US
Mailing Address - Phone:757-769-7155
Mailing Address - Fax:888-456-0253
Practice Address - Street 1:616 VIRGINIA BEACH BLVD
Practice Address - Street 2:#102
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451
Practice Address - Country:US
Practice Address - Phone:757-769-7155
Practice Address - Fax:888-456-0253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411282261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA234330Medicaid