Provider Demographics
NPI: | 1487105094 |
---|---|
Name: | H ANDREW FRATKIN, DDS, PC |
Entity type: | Organization |
Organization Name: | H ANDREW FRATKIN, DDS, PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DENTIST/OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | HOWARD |
Authorized Official - Middle Name: | ANDREW |
Authorized Official - Last Name: | FRATKIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 804-346-4066 |
Mailing Address - Street 1: | 2301 N PARHAM RD |
Mailing Address - Street 2: | SUITE 2 |
Mailing Address - City: | RICHMOND |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 23229-3171 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 804-346-4066 |
Mailing Address - Fax: | 804-346-5100 |
Practice Address - Street 1: | 2301 N PARHAM RD |
Practice Address - Street 2: | SUITE 2 |
Practice Address - City: | RICHMOND |
Practice Address - State: | VA |
Practice Address - Zip Code: | 23229-3171 |
Practice Address - Country: | US |
Practice Address - Phone: | 804-346-4066 |
Practice Address - Fax: | 804-346-5100 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | CENTRAL VIRGINIA DENTAL CARE |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2016-10-18 |
Last Update Date: | 2016-10-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Single Specialty |