Provider Demographics
NPI:1710348537
Name:DEPARTMENT OF HEALTH, GOVT OF THE VIRGIN ISLAND, DENTAL PUBLIC HELATH
Entity Type:Organization
Organization Name:DEPARTMENT OF HEALTH, GOVT OF THE VIRGIN ISLAND, DENTAL PUBLIC HELATH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:340-718-1311
Mailing Address - Street 1:3500 ESTATE RICHMOND
Mailing Address - Street 2:DEPT OF HEALTH CHARLES HARWOOD CO
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820
Mailing Address - Country:US
Mailing Address - Phone:340-718-1311
Mailing Address - Fax:340-718-1376
Practice Address - Street 1:3500 ESTATE RICHMOND
Practice Address - Street 2:DEPT OF HEALTH CHARLES HARWOOD CO
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-718-1311
Practice Address - Fax:340-718-1376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VIHR813A & CN123AOtherMEDICARE PTAN