Provider Demographics
NPI:1700183241
Name:WHITE-THWEATT CH, DDS, PC
Entity Type:Organization
Organization Name:WHITE-THWEATT CH, DDS, PC
Other - Org Name:COLONIAL HEIGHTS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MONSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:804-526-0807
Mailing Address - Street 1:3401 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-1417
Mailing Address - Country:US
Mailing Address - Phone:804-526-0807
Mailing Address - Fax:804-526-9029
Practice Address - Street 1:3401 BOULEVARD
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1417
Practice Address - Country:US
Practice Address - Phone:804-526-0807
Practice Address - Fax:804-526-9029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411217122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty