Provider Demographics
NPI:1841357928
Name:MARK J HERMELIN DDS PC
Entity type:Organization
Organization Name:MARK J HERMELIN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS PC
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:HERMELIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-497-4746
Mailing Address - Street 1:337 EDWIN DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462
Mailing Address - Country:US
Mailing Address - Phone:757-497-4746
Mailing Address - Fax:757-497-3698
Practice Address - Street 1:337 EDWIN DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462
Practice Address - Country:US
Practice Address - Phone:757-497-4746
Practice Address - Fax:757-497-3698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010056311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty