Edina Gorman
Individual provider Active NPI General Practice Dentistry · Mechanicsville, VA
NPI 1114449402 · NPPES record last updated Aug 24, 2021
Key facts
- NPI
- 1114449402
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 018.002032 (IL)
- Practice address
- 6353 Mechanicsville Tpke
Mechanicsville, VA 23111 - Phone
- (804) 730-3400
- NPI assigned
- Jul 9, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 11, 2018 through Oct 11, 2026
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 018.002032 | IL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Virginia Family Dentistry PC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 018.002032 | IL | Yes |
Addresses
Primary practice location
6353 Mechanicsville Tpke
Mechanicsville, VA 23111
Mailing address
1612 Huguenot Rd
Midlothian, VA 23113
Phone (804) 794-9789
Other practice location 1
820 S Damen Ave
Chicago, IL 60612
Phone (312) 569-6619
Other practice location 2
820 S Damen Ave
Chicago, IL 60612
Phone (312) 569-6619
Other providers in Mechanicsville, VA
- Anita Gordon
- Demetria Y. Gordon
- Jennifer Gordon
- Kimberly Gordon
- Ruth Amanda Goring
- Carol W. Goss
- David Paul Gosselin
- Redouane Goulmamine
- Grace D. Shortt, LCSW Acsw LLC
- Grace Haven Management, Inc.
All providers in Mechanicsville, VA · General Practice Dentistry in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 24, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.