Provider Demographics
NPI:1760578637
Name:DRS BUSSEY MAYO & ARCHER LTD
Entity Type:Organization
Organization Name:DRS BUSSEY MAYO & ARCHER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING FINANCIAL COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANDALE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-486-5155
Mailing Address - Street 1:477 VIKING DRIVE
Mailing Address - Street 2:STE #215
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452
Mailing Address - Country:US
Mailing Address - Phone:757-486-5428
Mailing Address - Fax:757-486-4826
Practice Address - Street 1:477 VIKING DRIVE
Practice Address - Street 2:STE #215
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452
Practice Address - Country:US
Practice Address - Phone:757-486-5428
Practice Address - Fax:757-486-4826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010040661223E0200X
VA04010063231223E0200X
VA04014100521223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty