Provider Demographics
NPI:1336585702
Name:ADVANCED SEDATION DENTISTRY - HAMPTON
Entity Type:Organization
Organization Name:ADVANCED SEDATION DENTISTRY - HAMPTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:HARALAMBOS
Authorized Official - Middle Name:
Authorized Official - Last Name:GAROFALIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-240-5711
Mailing Address - Street 1:220 NAT TURNER BLVD S
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2899
Mailing Address - Country:US
Mailing Address - Phone:757-240-5711
Mailing Address - Fax:
Practice Address - Street 1:2111 HARTFORD RD
Practice Address - Street 2:SUITE D
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2576
Practice Address - Country:US
Practice Address - Phone:757-838-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410912261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical