Healthcare Provider Details

I. General information

NPI: 1225233158
Provider Name (Legal Business Name): COMMONWEALTH PROSTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8917 FARGO RD STE B
RICHMOND VA
23229-4500
US

IV. Provider business mailing address

8917 FARGO RD STE B
RICHMOND VA
23229-4500
US

V. Phone/Fax

Practice location:
  • Phone: 804-346-3366
  • Fax: 804-346-4956
Mailing address:
  • Phone: 804-346-3366
  • Fax: 804-346-4956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number0401410988
License Number StateVA

VIII. Authorized Official

Name: DR. DAVID MARK SCHLEIDER
Title or Position: PROSTHODONTIST
Credential: DMD
Phone: 804-346-3366