Healthcare Provider Details

I. General information

NPI: 1356833404
Provider Name (Legal Business Name): ATLANTIC DENTAL CARE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 DENBIGH BLVD SUITE 300
NEWPORT NEWS VA
23608
US

IV. Provider business mailing address

606 DENBIGH BLVD SUITE 300
NEWPORT NEWS VA
23608
US

V. Phone/Fax

Practice location:
  • Phone: 757-874-8612
  • Fax:
Mailing address:
  • Phone: 757-874-8612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401411255
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401411255
License Number StateVA

VIII. Authorized Official

Name: ALLAN HEATH CASH III
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 757-874-8612