Provider Demographics
NPI:1760855951
Name:BEHL ORTHODODNTICS
Entity Type:Organization
Organization Name:BEHL ORTHODODNTICS
Other - Org Name:TIMBERLAKE PEDIATRIC DENTISTRY AND BEHL ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-240-5711
Mailing Address - Street 1:446 EFFINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-3464
Mailing Address - Country:US
Mailing Address - Phone:757-325-9959
Mailing Address - Fax:
Practice Address - Street 1:4291 HOLLAND RD
Practice Address - Street 2:STE. 112
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1939
Practice Address - Country:US
Practice Address - Phone:757-918-7945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014109121223P0221X
VA04014129051223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty