Healthcare Provider Details

I. General information

NPI: 1437534708
Provider Name (Legal Business Name): COMMONWEALTH DENTAL ANESTHESIA ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 HAXALL PT UNIT 1004
RICHMOND VA
23219-3941
US

IV. Provider business mailing address

1101 HAXALL PT UNIT 1004
RICHMOND VA
23219-3941
US

V. Phone/Fax

Practice location:
  • Phone: 434-242-5446
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number StateVA

VIII. Authorized Official

Name: DR. HEATHER BALLENTINE
Title or Position: DENTIST ANESTHESIOLOGIST
Credential: DDS
Phone: 646-789-3860