=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487873196
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOMINION ORTHODONTICS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9221 CHAMBERLAYNE AVE
-----------------------------------------------------
City | MECHANICSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-427-7420
-----------------------------------------------------
Fax | 804-427-7423
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4305 LONG MEADOW XING
-----------------------------------------------------
City | GLEN ALLEN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23059-5131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-261-0016
-----------------------------------------------------
Fax | 804-427-7423
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICER
-----------------------------------------------------
Name | DR. ELIZABETH W MEI
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 804-427-7420
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 0401008096
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------