Provider Demographics
NPI:1649747080
Name:ALTHOUSE FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:ALTHOUSE FAMILY DENTISTRY PLLC
Other - Org Name:A DIVISION OF ATLANTIC DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:ALTHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-497-4746
Mailing Address - Street 1:337 EDWIN DR STE 101
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4560
Mailing Address - Country:US
Mailing Address - Phone:757-497-4746
Mailing Address - Fax:
Practice Address - Street 1:337 EDWIN DR STE 101
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4560
Practice Address - Country:US
Practice Address - Phone:757-497-4746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC DENTAL CARE, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-24
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1548367279OtherNPI