Provider Demographics
NPI:1700165974
Name:HOWARD A. MENDELSOHN D.D.S, PC
Entity Type:Organization
Organization Name:HOWARD A. MENDELSOHN D.D.S, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MENDELSOHN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-424-1976
Mailing Address - Street 1:6095 INDIAN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-3818
Mailing Address - Country:US
Mailing Address - Phone:757-424-1976
Mailing Address - Fax:757-424-3152
Practice Address - Street 1:6095 INDIAN RIVER RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-3818
Practice Address - Country:US
Practice Address - Phone:757-424-1976
Practice Address - Fax:757-424-3152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010039921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA150579OtherUNITED CONCORDIA
VA03992OtherDELTA
VA350128OtherBLUE CROSS BLUE SHIELD