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General NPI Number Information
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NPI Number | 1295964955
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTISTRY OF VIRGINIA, PLLC
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Dates
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Enumeration Date | 07/02/2009
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Last Update Date | 10/11/2009
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Provider Practice Location Address
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Address Line | 8203 CENTER PATH LANE SUITE A
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City | MECHANICSVILLE
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State | VA
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Zip | 23116
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Country | US
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Telephone | 804-746-7382
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Fax | 804-746-3025
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Provider Business Mailing Address
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Address Line | 8203 CENTER PATH LANE SUITE A
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City | MECHANICSVILLE
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State | VA
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Zip | 23116
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Country | US
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Telephone | 804-746-7382
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Fax | 804-746-3025
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. ANDREW D ZIMA JR.
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Credential | DDS
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Telephone | 804-746-7382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 0401411085
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 0401412165
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License Number State | VA
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