Provider Demographics
NPI:1689910044
Name:PEDRO L CASINGAL JR DDS PC
Entity Type:Organization
Organization Name:PEDRO L CASINGAL JR DDS PC
Other - Org Name:A DIVISION OF ATLANTIC DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:L
Authorized Official - Last Name:CASINGAL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-482-7977
Mailing Address - Street 1:810 BATTLEFIELD BLVD S
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-6611
Mailing Address - Country:US
Mailing Address - Phone:757-482-7977
Mailing Address - Fax:757-482-8769
Practice Address - Street 1:810 BATTLEFIELD BLVD S
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-6611
Practice Address - Country:US
Practice Address - Phone:757-482-7977
Practice Address - Fax:757-482-8769
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC DENTAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008632122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty