Provider Demographics
NPI:1669721866
Name:RICHMOND DENTAL SLEEP MEDICINE LLC
Entity type:Organization
Organization Name:RICHMOND DENTAL SLEEP MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MONACELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-746-2669
Mailing Address - Street 1:1343 E WILLIAMSBURG RD
Mailing Address - Street 2:
Mailing Address - City:SANDSTON
Mailing Address - State:VA
Mailing Address - Zip Code:23150-1723
Mailing Address - Country:US
Mailing Address - Phone:804-746-2669
Mailing Address - Fax:804-737-1745
Practice Address - Street 1:9448 CHAMBERLAYNE RD
Practice Address - Street 2:SUITE B
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2889
Practice Address - Country:US
Practice Address - Phone:804-746-2669
Practice Address - Fax:804-737-1745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-04
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401004464122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7149750001Medicare NSC