Provider Demographics
NPI:1891126702
Name:CENTRE FOR DENTAL EXCELLENCE
Entity Type:Organization
Organization Name:CENTRE FOR DENTAL EXCELLENCE
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:THOMAS
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:DUNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-427-7130
Mailing Address - Street 1:2008 GENERAL BOOTH BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-5910
Mailing Address - Country:US
Mailing Address - Phone:757-427-7130
Mailing Address - Fax:757-427-7135
Practice Address - Street 1:2008 GENERAL BOOTH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-5910
Practice Address - Country:US
Practice Address - Phone:757-427-7130
Practice Address - Fax:757-427-7135
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC DENTAL CARE, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010078981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty