Provider Demographics
NPI:1356860134
Name:COMMONWEALTH PEDIATRIC DENTISTRY, PLLC
Entity type:Organization
Organization Name:COMMONWEALTH PEDIATRIC DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-339-6957
Mailing Address - Street 1:201 A ST
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-1613
Mailing Address - Country:US
Mailing Address - Phone:804-339-6957
Mailing Address - Fax:
Practice Address - Street 1:7032 FOREST HILL AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-1655
Practice Address - Country:US
Practice Address - Phone:804-621-8299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL VIRGINIA DENTAL CARE PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014121651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty