Provider Demographics
NPI:1336167006
Name:CENTRAL VIRGINIA ORAL & FACIAL SURGEONS, PLC
Entity Type:Organization
Organization Name:CENTRAL VIRGINIA ORAL & FACIAL SURGEONS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:W
Authorized Official - Last Name:EISENHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:434-973-3348
Mailing Address - Street 1:244 HYDRAULIC RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-8124
Mailing Address - Country:US
Mailing Address - Phone:434-973-3348
Mailing Address - Fax:434-977-5790
Practice Address - Street 1:244 HYDRAULIC RIDGE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8124
Practice Address - Country:US
Practice Address - Phone:434-973-3348
Practice Address - Fax:434-977-5790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========OtherTAX ID NUMBER