Provider Demographics
NPI:1831434711
Name:ATLANTIC DENTAL CARE, PLC
Entity type:Organization
Organization Name:ATLANTIC DENTAL CARE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAYBORN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-486-4469
Mailing Address - Street 1:737 LITTLE NECK RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-5813
Mailing Address - Country:US
Mailing Address - Phone:757-486-4469
Mailing Address - Fax:757-961-6882
Practice Address - Street 1:737 LITTLE NECK RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-5813
Practice Address - Country:US
Practice Address - Phone:757-486-4469
Practice Address - Fax:757-961-6882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty