Healthcare Provider Details

I. General information

NPI: 1487196309
Provider Name (Legal Business Name): ATKINS, MAESTRELLO, MILLER AND ASSOCIATES PEDIATRIC DENTISTRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 GASKINS RD
RICHMOND VA
23238-1468
US

IV. Provider business mailing address

2560 GASKINS RD
RICHMOND VA
23238-1468
US

V. Phone/Fax

Practice location:
  • Phone: 804-741-2226
  • Fax: 804-741-6751
Mailing address:
  • Phone: 804-741-2226
  • Fax: 804-741-6751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CARL ATKINS
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 804-741-2226