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General NPI Number Information
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NPI Number | 1114079480
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Entity Type | Organization
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Legal Business Name | SHORT PUMPS DENTAL
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 3811 WESTERRE PKWY SUITE C
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City | HENRICO
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State | VA
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Zip | 23233-1329
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Country | US
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Telephone | 804-747-0116
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Fax | 804-747-6881
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Provider Business Mailing Address
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Address Line | 3811 WESTERRE PKWY SUITE C
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City | HENRICO
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State | VA
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Zip | 23233-1329
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Country | US
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Telephone | 804-747-0116
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Fax | 804-747-6881
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Authorized Official
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Title or Position | DENTIST / OWNER
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Name | DR. ROMAN T HAUEIS
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Credential | DMD
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Telephone | 804-747-0116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401008563
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401007159
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License Number State | VA
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