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General NPI Number Information
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NPI Number | 1609260439
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Entity Type | Organization
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Legal Business Name | DENTAL ANESTHESIA ASSOCIATES PLLC
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 03/18/2015
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Provider Practice Location Address
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Address Line | 4545 RIVERSIDE DR SUITE C
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City | DANVILLE
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State | VA
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Zip | 24541-5172
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Country | US
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Telephone | 434-791-2142
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Fax |
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Provider Business Mailing Address
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Address Line | 1009 SOMER CHASE CT
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-5775
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Country | US
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Telephone | 510-329-9554
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | NAVDEEP SANDHU
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Credential | DDS
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Telephone | 510-329-9554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 0401414064
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License Number State | VA
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