Provider Demographics
NPI:1255766234
Name:ADVANCED SEDATION SERVICES, LLC
Entity type:Organization
Organization Name:ADVANCED SEDATION SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FUTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-769-7155
Mailing Address - Street 1:200 BATTLEFIELD BLVD N STE 4
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3975
Mailing Address - Country:US
Mailing Address - Phone:757-769-7155
Mailing Address - Fax:888-456-0253
Practice Address - Street 1:200 BATTLEFIELD BLVD N STE 4
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3975
Practice Address - Country:US
Practice Address - Phone:757-769-7155
Practice Address - Fax:888-456-0253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA411283261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1346468220Medicaid