Provider Demographics
NPI:1609260439
Name:DENTAL ANESTHESIA ASSOCIATES PLLC
Entity Type:Organization
Organization Name:DENTAL ANESTHESIA ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NAVDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDHU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-329-9554
Mailing Address - Street 1:1009 SOMER CHASE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-5775
Mailing Address - Country:US
Mailing Address - Phone:510-329-9554
Mailing Address - Fax:
Practice Address - Street 1:4545 RIVERSIDE DR
Practice Address - Street 2:SUITE C
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-5172
Practice Address - Country:US
Practice Address - Phone:434-791-2142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414064261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental