Provider Demographics
NPI:1720060221
Name:ATKINS, TANDRA FAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:TANDRA
Middle Name:FAY
Last Name:ATKINS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4239 HOLLAND RD STE 762A
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1943
Mailing Address - Country:US
Mailing Address - Phone:757-467-5665
Mailing Address - Fax:
Practice Address - Street 1:4239 HOLLAND RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1941
Practice Address - Country:US
Practice Address - Phone:757-906-3063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2022-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN07730122300000X
VA04014182031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist