Provider Demographics
NPI:1972054773
Name:ANTONE EXUM DDS
Entity Type:Organization
Organization Name:ANTONE EXUM DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONE
Authorized Official - Middle Name:C
Authorized Official - Last Name:EXUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-212-2501
Mailing Address - Street 1:10124 W BROAD ST
Mailing Address - Street 2:STE Q
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3330
Mailing Address - Country:US
Mailing Address - Phone:804-212-2501
Mailing Address - Fax:804-887-6238
Practice Address - Street 1:10124 W BROAD ST
Practice Address - Street 2:STE Q
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3330
Practice Address - Country:US
Practice Address - Phone:804-212-2501
Practice Address - Fax:804-887-6238
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL VIRGINIA DENTAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010069941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty